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At present, various scar assessment scales are available, but not one has been shown to be reliable, consistent, feasible, and valid at the same time. Furthermore, the existing scar assessment scales appear to attach little weight to the opinion of the patient. The newly developed Patient and Observer Scar Assessment Scale consists of two numeric scales: the Patient Scar Assessment Scale (patient scale) and the Observer Scar Assessment Scale (observer scale). The patient and observer scales have to be completed by the patient and the observer, respectively. The patient scale's consistency and the observer scale's consistency, reliability, and feasibility were tested. For the Vancouver Scar Scale, which is the most frequently used scar assessment scale at present, the same statistical measurements were examined and the results of the observer scale and the Vancouver scale were compared. The concurrent validity of the observer scale was tested with a correlation to the Vancouver scale. Furthermore, the authors examined which specific characteristics significantly influence the general opinion of the patient and the observers on the scar areas. Four independent observers have each used the observer scale and the Vancouver scale to assess 49 burn scar areas of 3 x 3 cm belonging to 20 different patients. Subsequently, the patients completed the patient scale for their scar areas. The (internal) consistency of both the patient and the observer scales was acceptable (Cronbach's alpha, 0.76 and 0.69, respectively), whereas the consistency of the Vancouver scale appeared not to be acceptable (alpha, 0.49). The reliability of the observer scale completed by a single observer was acceptable (r = 0.73). The reliability of the Vancouver scale completed by a single observer was lower (r = 0.69). The observer scale showed better agreement than the Vancouver scale because the coefficient of variation was lower (18 percent and 22 percent, respectively). The concurrent validity of the observer scale in relation to the Vancouver scale is high (r = 0.89, p < 0.001). Linear regression of the general opinions on scars of the observer and the patient showed that the observer's opinion is influenced by vascularization, thickness, pigmentation, and relief, whereas the patient's opinion is mainly influenced by itching and the thickness of the scar. Such an impact of itching and thickness of the scar on the patient's opinion is an important and novel finding. The Patient and Observer Scar Assessment Scale offers a suitable, reliable, and complete scar evaluation tool.
OBJECTIVE: To develop and evaluate scaling and scoring assumptions, and the reliability and the validity of a Chinese version of the SF-36 scales. METHODS: A multi-stage mixed sampling procedure was used to select a representative sample of the general population. The sample size was 1 000 households. All family members of a selected household, aged 18 and older, completed a survey by self-administration. Formal psychometric methods for testing assumptions underlying item scoring and scale construction were used according to the standard procedure of the IQOLA Project. RESULTS: Of the 1 985 collected questionnaires, 1 972 were qualified. Of them, 1 688 (85.6%) were respondents. 1 316 respondents answered all 36 items, while the remaining (372 respondents) answered with one or several missing responses. Among the non-respondents, 65.5% were illiteracy or quasi-illiteracy. The assumption of equal intervals was violated for the VT and MH scales. The recoded item values were used to calculate scale scores. The clustering and ordering of the item means were approximately the same as that of the source version and other two Chinese versions. The items in each scale had similar standard deviations except those in the PF, BP, SF scales. The correlations between an item and its hypothesized scale were identical for all except the SF and VT scales. The scaling success rates of convergent validity were 0% for the SF scale, 75% for the VT scale, and 100% for the other six scales. The scaling success rates of discriminat validity ranged from 87.5% to 100% for all scales except for the SF scale. The Cronbach' alpha coefficients of internal consistency reliability ranged from 0.72 to 0.88, which were satisfactory for group comparison except 0.39 for the SF scale and 0.66 for the VT scale. The two-weeks test-retest reliability coefficient ranged from 0.66 to 0.94. Factor analysis identified two principal components: a "physical" factor and a "mental" factor. Taken together, these two factors could be used to explain 56.3% of the total variance. CONCLUSION: The Chinese version of the SF-36 Health Survey Scale has achieved conceptual equivalence and satisfied the psychometric scaling assumptions well enough to warrant wide use in China. Known-groups validity will give more meaningful evidences of the validity of the Chinese SF-36 scales.
This investigation covers a survey of the scale insects associating with some ornamental plants at three chosen public gardens as well as at the experimental farm of the Agricultural Research Station in Alexandria Governorate, Egypt. A total of nineteen scale insect species belonging to sixteen genera related to four families of the super-family Coccoidea were found infesting eighteen ornamental plants during the period from April, 1998 up to March, 1999. These species are: Family: Asterolecaniidae--Represented by one species only The fig scale Russelaspis pustulans; (Cockerell) = (Asterolecanium pustulans Cock). Family: Coccidae--Represented by the seven species Florida wax scale. Ceroplastes floridensis Comstock, Green shield scale. Chloropulvinaria psidii (Maskell), Long brown scale. Caccus elongatus (Douglas), Brown soft scale Coccus hesperidum (Linn.), Tessellated scale. Eucalymnatus tessellatus (Signoret), Hemispherical scale. Saissetia coffeae (Walker), and Olive soft scale. Saissetia oleae (Olivier) Family: Diaspididae--Represented by the ten species: Oleander scale. Aspidiotus hederae (Vallot), Minute cypress scale. Carulaspis minima (Targioni-Tozzetti), Dictyosprmum scale Chrysomphalus dictyospermi (Morgan), Palm fiorinia scale. Fiorinia fioriniae (Targioni), Latania scale Hemiberlisia lataniae (Signoret), Fig scale. Lepidosaphes ficus (Signoret), Snow scale. Lineaspis striata (Newstead), Masked scale. Mycetaspis personata (Comstock), Olive scale. Parlatoria oleae (Colvee), and White peach scale Pseudaulacaspis pentagona (Targioni-Tozzetti), Family: Eriococcidae--Represented by one species only Eriococcus araucariae (Maskell). During the same study, many species of natural enemies (nine parasitoids and eight predators), were also noticed to be associated with the aforementioned scale insects.
With the introduction and wide acceptance of the Glasgow coma scale, some progress was made in 1980s. Various types of coma scale were offered from different centers of the world for assessing coma and impaired consciousness. The existing coma scales may be divided into two main categories: (1) multi-dimensional scale, e.g., Glasgow coma scale (GCS), Glasgow-Liege coma scale (G-LCS), Maryland coma scale (MCS); and (2) uni-dimensional scale, e.g., Edinburgh-2 coma scale (E2CS). There is evidence that the uni-dimensional coma scale is better than the multi-dimensional coma scale. The major drawbacks in the multi-dimensional coma scale is the total figure of coma level must be envisaged stereographially. The sum of scores of three dimensions of GCS, as in a multi-dimensional scale, consists of 13 levels from 3 through 15, but the numbers of simple combination constituting each score are considerable. No. 9 in GCS scale may be made up of 18 combinations. E2CS, as an uni-dimensional scale, seems to be an improvement over GCS. On the basis of comparison between two main categories of coma scale and considering the shortcomings of E2CS, a modified uni-dimensional ordinal coma scale called "Chengdu-1 Coma scale" (C1CS) was proposed and applied for evaluating the depth of coma and for prognosticating the patients' outcome. This study was based on 98 acutely head-injured patients treated in the Neurosurgical department of 1st Affiliated Hospital of WCUMS, from October 1983 through May 1984. The follow-up results showed that a good correlation was observed between the score of C1CS and the outcome scale score (Glasgow outcome scale, GOS) of the patients.
BACKGROUND: Clinicians and researchers often wish to know how patients perceive the likelihoods of health risks. Little work has been done to develop and validate scales and formats to measure perceptions of event probabilities, particularly low probabilities (i.e., <1%). OBJECTIVE: To compare a new visual analog scale with three benchmarks in terms of validity and reliability. DESIGN: Survey with retest after approximately two weeks. Respondents estimated the probabilities of six events with the new scale, which featured a "magnifying glass" to represent probabilities between 0 and 1% on a logarithmic scale. Participants estimated the same probabilities on three benchmarks: two linear visual analog scales (one labeled with words, one with numbers) and a "1 in x" scale. SUBJECTS: 100 veterans and family members and 107 university faculty and students. MEASURES: For each scale, the authors assessed: 1) validity-the correlation between participants' direct rankings (i.e., numbering them from 1 to 6) and scale-derived rankings of the relative probabilities of six events; 2) test-retest reliability-the correlation of responses from test to retest two weeks later; 3) usability (missing/ incorrect responses, participant evaluation). RESULTS: Both the magnifier and the two linear scales outperformed the "1 in x" scale on all criteria. The magnifier scale performed about as well as the two linear visual analog scales for validity (correlation between direct and scale-derived rankings = 0.72), reliability (test-retest correlation = 0.55), and usability (2% missing or incorrect responses, 65% rated it easy to use). 62% felt the magnifier scale was a "very good or good" indicator of their feelings about chance. The magnifier scale facilitated expression of low-probability judgments. For example, the estimated chance of parenting sextuplets was orders of magnitude lower on the magnifier scale (median perceived chance 10(-5)) than on its linear counterpart (10(-2)). Participants' assessments of high-probability events (e.g., chance of catching a cold in the next year) were not affected by the presence of the magnifier. CONCLUSIONS: The "1 in x" scale performs poorly and is very difficult for people to use. The magnifier scale and the linear number scale are similar in validity, reliability, and usability. However, only the magnifier scale makes it possible to elicit perceptions in the low-probability range (<1%).
Scale holds the key to understand pattern-process interactions, and indeed, becomes one of the corner-stone concepts in landscape ecology. Geographic Information System and remote sensing techniques provide an effective tool to characterize the spatial pattern and spatial heterogeneity at different scales. As an example, these techniques are applied to analyze the urban landscape diversity index, contagion index and fractal dimension on the SPOT remote sensing images at four scales. This paper modeled the semivariogram of these three landscape indices at different scales, and the results indicated that the spatial variance characters of diversity index, contagion index and fractal dimension were similar at different scales, which was spatial dependence. The spatial dependence was showed at each scale, the smaller the scale, the stronger the spatial dependence. With the scale reduced, more details of spatial variance were discovered. The contribution of spatial autocorrelation of these three indices to total spatial variance increased gradually, but when the scale was quite small, spatial variance analysis would destroy the interior structure of landscape system. The semivariogram models of different landscape indices were very different at the same scale, illuminating that these models were incomparable at different scales. According to above analyses and based on the study of urban land use structure, 1 km extent was the more perfect scale for studying the spatial variance of urban landscape pattern in Shanghai. The spatial variance of landscape indices had the character of scale-dependence, and was a function of scale. The results differed at different scales we chose, and thus, the influence of scales on pattern could not be neglected in the research of landscape ecology. The changes of these three landscape indices displayed the regularity of urban spatial structure at different scales, i. e., they were complicated and no regularity at small scale, polycentric at moderate scale, and circle-zoning at big scale.
BACKGROUND: Most scales used to assess prognosis after subarachnoid haemorrhage (SAH) are based on the level of consciousness of the patient. Based on information from a logistic regression model, Ogilvy et al. developed a new grading scheme (Massachussetts General Hospital (MGH) Scale) which applied a simple scoring method to each prognostic factor considered relevant such as level of consciousness, age, quantity of blood in the first CT scan and size of the aneurysm. The purpose of this study is to introduce a modified version of the MGH scale, built up using factors applicable to every patient suffering SAH, and compare this new scale to the World Federation of Neurological Surgeons scale (WFNS), the Glasgow Coma Scale (GCS) scale for SAH and the MGH scale. METHOD: A series of 442 patients consecutively admitted to Hospital 12 de Octubre between January 1990 and September 2001 with the diagnosis of spontaneous SAH were retrospectively reviewed. Outcome was assessed by means of the Glasgow Outcome Scale measured six months after hospital discharge. Differences between grades of the WFNS, the GCS scale for SAH, the MGH scale and the new scale were computed by chi2 statistics. ROC curves were plotted for the different scales and their areas compared. FINDINGS: Both WFNS and GCS scales fail to present significant differences between most of their grades, while the proposed scale shows a constant inter-grade significant difference in predicting outcome. The proposed scale presents a significantly higher prognostic efficacy in the whole series of patients suffering spontaneous SAH, patients with idiopathic subarachnoid haemorrhage (ISAH) and patients with confirmed aneurysmal SAH. The MGH scale is not applicable to some groups of patients suffering SAH. INTERPRETATION: Grading scales including additional factors to the level of consciousness show higher prognostic efficacy. The proposed modification of the MGH scale makes it applicable to every patient suffering SAH without losing its prediction capability.
AIMS AND OBJECTIVES: This review aims to explore the research available relating to three commonly used pain rating scales, the Visual Analogue Scale, the Verbal Rating Scale and the Numerical Rating Scale. The review provides information needed to understand the main properties of the scales. BACKGROUND: Data generated from pain-rating scales can be easily misunderstood. This review can help clinicians to understand the main features of these tools and thus use them effectively. METHOD: A MedLine review via PubMed was carried out with no restriction of age of papers retrieved. Papers were examined for methodological soundness before being included. The search terms initially included pain rating scales, pain measurement, Visual Analogue Scale, VAS, Verbal Rating Scale, VRS, Numerical/numeric Rating Scale, NRS. The reference lists of retrieved articles were used to generate more papers and search terms. Only English Language papers were examined. CONCLUSIONS: All three pain-rating scales are valid, reliable and appropriate for use in clinical practice, although the Visual Analogue Scale has more practical difficulties than the Verbal Rating Scale or the Numerical Rating Scale. For general purposes the Numerical Rating Scale has good sensitivity and generates data that can be statistically analysed for audit purposes. Patients who seek a sensitive pain-rating scale would probably choose this one. For simplicity patients prefer the Verbal Rating Scale, but it lacks sensitivity and the data it produces can be misunderstood. RELEVANCE TO CLINICAL PRACTICE: In order to use pain-rating scales well clinicians need to appreciate the potential for error within the tools, and the potential they have to provide the required information. Interpretation of the data from a pain-rating scale is not as straightforward as it might first appear.
The Modified Norris Scale is a rating scale for amyotrophic lateral sclerosis (ALS), which consists of two parts, the Limb Norris Scale and the Norris Bulbar Scale. The Limb Scale has 21 items to evaluate extremity function and the Bulbar Scale has 13 items to evaluate bulbar function. Each item is rated in 4 ordinal categories. Considering the habitual difference, we translated the English scale into Japanese one with minor modification, and added more detailed explanations for all categories of each item. Then we examined reliability and factorial structure of the translated scale. The subjects were 23 patients with motor disturbance and each subject was rated twice by 2-4 neurologists. As a measure of reliability, the Kappa coefficient proposed by Cohen (1960) and Kraemer (1980) was calculated for each item and the intraclass correlation coefficient (ICC) was evaluated for total scores of each of two scales. To analyze the factorial structure, the factor analysis was carried out. The minimum and the maximum Kappa values were .70 and .97 for intra-rater reliability of the Limb Scale's items, .60 and .83 for inter-rater reliability of the Limb Scale's items, .41 and 1.00 for intra-rater reliability of the Bulbar Scale's items and .26 and .81 for inter-rater reliability of the Bulbar Scale's items, respectively. Concerning the factorial structure, the contribution of the first factor was 83.6% for the Limb Scale and that for the Bulbar Scale was 66.7%. This indicates unidimensionality of both Scales. The ICCs for the total scores were .97 (95%C.I. .95-.99) for the Limb Scale and .86 (.73-.93) for the Bulbar Scale, respectively. On the basis of these results, the Scale has unidimensionality and high reliability enough for practical use.
This study examined concentrations of metals in fish scales taken from Arctic grayling using laser ablation-inductively coupled plasma mass spectrometry (LA-ICPMS). The purpose was to assess whether scale metal concentrations reflected whole muscle metal concentrations and whether the spatial distribution of metals within an individual scale varied among the growth annuli of the scales. Ten elements (Mg, Ca, Ni, Zn, As, Se, Cd, Sb, Hg, and Pb) were measured in 10 to 16 ablation sites (5 microm radius) on each scale sample from Arctic grayling (Thymallus arcticus) (n = 10 fish). Ca, Mg, and Zn were at physiological levels in all scale samples. Se, Hg, and As were also detected in all scale samples. Only Cd was below detection limits of the LA-ICPMS for all samples, but some of the samples were below detection limits for Sb, Pb, and Ni. The mean scale concentrations for Se, Hg, and Pb were not significantly different from the muscle concentrations and individual fish values were within fourfold of each other. Cd was not detected in either muscle or scale tissue, whereas Sb was detected at low levels in some scale samples but not in any of the muscle samples. Similarly, As was detected in all scale samples but not in muscle, and Ni was detected almost all scale samples but only in one of the muscle samples. Therefore, there were good qualitative and quantitative agreements between the metal concentrations in scale and muscle tissues, with LA-ICPMS analysis of scales appearing to be a more sensitive method of detecting the body burden of Ni and As when compared with muscle tissue. Correlation analyses, performed for Pb, Hg, and Se concentrations, revealed that the scale concentrations for these three metals generally exceeded those of the muscle at low muscle concentrations. The LA-ICPMS analysis of scales had the capability to resolve significant spatial differences in metal concentrations within a fish scale. We conclude that metal analysis of fish scales using LA-ICPMS shows considerable promise as a nonlethal analytical tool to assess metal body burden in fish that could possibly generate a historic record of metal exposure. However, comprehensive validation experiments are still needed.
Many broad-scale, environmental phenomena can be investigated by extrapolating from detailed study of events at a small scale. This paper evaluates approaches to the use of physiologically based soil-plant models for addressing broad-scale, environmental issues. When the space and time domains of a soil-plant simulator are extended, there is an increase in the variability of soil, plant, and weather variables, which can be dealt with by what is called extended-range modeling, ERM. There may also be a gain of phenomena not represented at the small scale, which can be dealt with by what is called phenomena-added modeling, PAM. As an example of ERM, a Monte Carlo procedure, called Latin hypercube sampling, is used to estimate annual photosynthate production of an oak-hickory forest under three atmospheric CO(2) concentrations. Phenomena-added modeling is illustrated by scaling up spatially from a vegetated plot to a watershed, and scaling up temporally from a physiological model with hourly time steps to a forest-succession model operating on annual time steps. Where large-scale processes take place on a time scale similar to, or faster than, that of small-scale processes (plot-watershed case), less computation is required if the small-scale processes are built into the large-scale model and ERM is conducted with the expanded model. Phenomena-added modeling may be conducted by information transfer from a small-scale simulator to a large-scale simulator. This is also possible with Latin hypercube sampling by using the output frequency distributions from the small-scale model as input distributions for the large-scale model. The final outputs at the large scale are also frequency distributions, and these can be used to determine confidence intervals for statistical comparisons among modeling scenarios. The ERM and PAM methods are data and computer intensive; nevertheless, they can fill an important need for addressing large-scale issues that cannot be adequately addressed through other scaling up methods.
OBJECTIVES: To determine: (1) the psychometric properties and utility of 5 types of commonly used pain rating scales when used with younger and older adults, (2) factors related to failure to successfully use a pain rating scale, (3) pain rating scale preference, and (4) factors impacting scale preference. METHODS: A quasi-experimental design was used to gather data from a sample of 86 younger (age 25-55) and 89 older (age 65-94) adult volunteer subjects. Responses of subjects to experimentally induced thermal stimuli were measured with the following pain intensity rating scales: vertical visual analog scale (VAS), 21-point Numeric Rating Scale (NRS), Verbal Descriptor Scale (VDS), 11-point Verbal Numeric Rating Scale (VNS), and Faces Pain Scale (FPS). RESULTS: All 5 pain scales were effective in discriminating different levels of pain sensation; however the VDS was most sensitive and reliable. Failure rates for pain scale completion were minimal, except for the VAS. Although age did not impact failure to properly use this pain intensity rating scale, but rather those conditions more commonly associated with advanced age, including cognitive and psychomotor impairment did. The scale most preferred to represent pain intensity in both cohorts of subjects was the NRS, followed by the VDS. Scale preference was not related to cognitive status, educational level, age, race, or sex. CONCLUSION: Although all 5 of the pain intensity rating scales were psychometrically sound when used with either age group, failures, internal consistency reliability, construct validity, scale sensitivity, and preference suggest that the VDS is the scale of choice for assessing pain intensity among older adults, including those with mild to moderate cognitive impairment.
Role functioning and its limitations due to one's health is an important aspect of health-related quality of life (HRQoL). The Medical Outcomes Study (MOS) SF-36 includes 2 role functioning scales: role limitations due to physical health problems (RP) or emotional problems (RE). Although they capture important concepts of HRQoL, these 2 scales have some limitations in their measurement properties. Using dichotomized sets of response choices, the scales are limited in their distributional properties (eg, higher standard deviation than other SF-36 scales) and ability to discriminate between clinically relevant groups. In this study, we ascertain the improvements to these 2 scales using 5-point ordinal response choices for each of the scale items. Two thousand one hundred sixty-two patients from the Veterans Health Study (VHS), an observational study of health outcomes in patients receiving ambulatory care, completed a health status questionnaire and a medical history. The health questionnaire included (1) the MOS SF-36, in which the RP and RE items used dichotomized yes/no responses; and (2) a set of modified RP and RE items that used 5-response choices for each of the items, ranging from "no, none of the time" to "yes, all of the time." We compared the original and modified RP and RE scales using internal consistency reliability and factor analysis. We tested item convergent and discriminant validity using multitrait scaling, and scale discriminant validity using ordinary least squares regression. Results indicate that the modifications to the original RP and RE scales accomplish important gains in the distributional properties of the scales. The floor and ceiling effects of the 2 scales have been reduced and the reliability of the RP scale has increased (0.87-0.95). Factor analysis and multitrait scaling tests indicate that the modified items have the same interpretation as the original items. Tests of discriminant validity indicate that the modified RP and RE scales have greater explanatory power for measures of disease burden, depression, and disease severity. The modified SF-36 role scales are clearly superior to the original versions. The modifications have increased the explained variability, suggesting greater explanatory power and more information obtained by the role functioning measures. The modified RP and RE are capturing a wider spectrum of disease severity, in part due to the lowering of the floor and raising of the ceiling of the scales. Additional work needs to test these improvements in other populations and to expand the analysis to track the responsiveness of the modified scales to clinically and socially important changes over time.
The relationship between the MMPI-2 restructured clinical scales and the original clinical scales was evaluated using an outpatient clinical sample (N = 150). Similar patterns of correlations to those reported by Tellegen et al. in 2003, such as high correlations between the restructured scales and their original scale counterparts and lower intercorrelations among the restructured scales than among the original scales, were found in the outpatient sample. The former provided evidence of convergence between the two sets of scales, whereas the latter increases the potential for discriminant validity in the restructured scale profiles. Mean T-scores of the restructured scales were significantly lower than their original scale counterparts for every clinical scale except Scale 1 (hypochondriasis). Individual profiles exhibited fewer scale elevations using the restructured clinical scales (M = 2.15, Mdn = 2.0) than the original clinical scales (M = 3.29, Mdn = 3.0). The majority of client profiles (56%) had fewer scale elevations when plotted using the restructured scales versus the original clinical scales.
We compared three self-rating scales (the Geriatric Depression Scale, the Zung Scale, and the Center for Epidemiologic Studies Depression Scale) with three examiner-rating scales (the Hamilton Rating Scale, the Comprehensive Psychopathological Rating Scale-Depression, and the Cornell Scale), to see which was best for 40 elderly (mean age 80 years) stroke patients, 17 of whom were depressed according to clinical examination. External validity and concurrent validity were good for all except the Cornell Scale. Reliability (internal consistency) showed that some items were not significantly correlated, which might be explained by our selection of the patients. The Geriatric Depression Scale, the Zung Scale, and the Comprehensive Psychopathological Rating Scale-Depression had the highest sensitivity, and the Zung Scale had the highest positive predictive value (93%). With regard to internal consistency, sensitivity, and predictive value, the best self-rating scales were the Geriatric Depression and the Zung scales and the best examiner-rating scale was the Comprehensive Psychopathological Rating Scale-Depression.