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Entrepreneurship is a process that applies to all types and sizes of tribal organizations. This chapter reviews steps in the process of preparing an idea for implementation. In its simplest version, this entails creating an idea, testing that idea with buyers, and making adaptive changes to the idea as it evolves. By focusing on the concept of “value creation,” an entrepreneur ensures that new products and services are not only feasible to create, but also have a market of potential buyers. Validating new products and services with potential buyers before large sums are invested (being “lean”) helps to reduce some of the financial risk inherent in new ventures. Native American entrepreneurs often use their cultural identity as the basis of their business model. Business models and strategies specific to American Indian entrepreneurs are discussed.
Good research design includes choosing what to measure and how to measure it. We can’t measure everything. Fortunately, clear predictions dictate the measurements we need to make to test them. This chapter provides general advice on methods, then covers the importance of the validity, accuracy, sensitivity of the measures we use. I end with a reminder that methods must also be feasible.
To assess agreement between established methods of estimating salt intake from spot urine collections and 24 h urinary Na (24hUNa) and then to develop a valid formula that can be used in the Iranian population to estimate salt intake from spot urine samples.
A validation study. Three spot urine samples were collected (fasting second-void morning; afternoon; evening) on the same day as a 24 h urine collection. We estimated 24hUNa from spot specimens using the Kawasaki, Tanaka and INTERSALT equations. Two new formulas were developed, the Iran formula 1 (Iran 1) and Iran formula 2 (Iran 2), based on our population characteristics.
Iranian adults recruited in 2014–2015.
Healthy volunteer adults aged ≥18 years.
With all three spot urine specimens, predicted population 24hUNa was underestimated based on the INTERSALT equation (−469 to −708 mg/d; all P < 0·05) and conversely overestimation occurred with the Kawasaki equation (926 to 1080 mg/d; all P < 0·01). The Tanaka equation produced comparable estimates to measured 24hUNa (–151 to 86 mg/d; all P > 0·49). The newly derived formulas, Iran 1 and Iran 2, showed less mean bias than the established equations (Iran 1: 43 to 80 mg/d, all P > 0·55; Iran 2: 22 to 90 mg/d, all P > 0·50).
In this Iranian sample, the Tanaka equation and newly derived formulas produced group-level estimates comparable to measured 24hUNa. The newly developed formulas showed less mean bias than established equations; however, they need to be tested for generalization in a larger sample.
The development of a second version of the Yale Food Addiction Scale (YFAS) coincides with the latest updates in the diagnosis of addiction as documented in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders. The objective of the present study was to translate the YFAS 2.0 into the Malay language and test its psychometric properties in a primary-care population.
Patients were assessed for food addiction utilizing the Malay YFAS 2.0. The participants were also assessed for eating disorder using the validated Malay Binge Eating Scale. The psychometric properties of the YFAS 2.0 were determined by analysing factor structure, overall item statistics, internal consistency and construct validity.
Between 2017 and 2018, participants were chosen from a regional primary-care clinic in the district of Seremban, Malaysia.
Patients (n 382) from a regional primary-care clinic.
The prevalence of food addiction was 5·0%. A two-factor structure of the YFAS was confirmed as the most optimal solution for the scale via confirmatory factor analysis. In both its diagnostic and symptom count version, the YFAS 2.0 had good internal consistency (Kuder–Richardson α > 0·80 and McDonald’s ω > 0·9).
We validated a psychometrically sound Malay version of the YFAS 2.0 in a primary-care population. Both diagnostic and symptom count versions of the scale had robust psychometric properties. The questionnaire can be used to develop health promotion strategies to detect food addiction tendencies in a general population.
To examine the psychometric properties of an Arabic version of the Child Feeding Questionnaire (CFQ-A) in a sample of Saudi pre-schoolers and their mothers.
Cross-sectional study. Mothers completed questionnaires over the telephone and child anthropometry was measured objectively using standardized procedures; BMI Z-scores (BMIZ) were calculated based on the age- and sex-specific WHO growth standards and reference data. Confirmatory factor analysis was used to examine the original seven-factor CFQ model, as well as a modified nine-factor model. Cronbach’s α was calculated to examine the internal consistency of each factor; Spearman correlation was used to examine 2-week retest reliability. Factor–factor and factor–child BMIZ correlations were examined.
Jeddah, Kingdom of Saudi Arabia.
A total of 209 mothers and children were recruited from eight different pre-schools.
Both the original seven-factor and modified nine-factor CFQ-A exhibited good fit (root-mean-square-error of approximation < 0·05). Six out of nine factors had excellent internal consistency and all factors showed excellent 2-week test–retest reliability. There were significant correlations between child BMIZ and five out of the nine factors; Perceived Child Weight, Perceived Parent Weight, Restriction and Monitoring were each positively correlated with child BMIZ, while Concern about Child’s Diet was negatively correlated with child BMIZ.
The study provided evidence supporting the validity and reliability of the original seven-factor and modified nine-factor CFQ-A. Future studies are needed to further establish the psychometric properties of the CFQ-A in addition to other feeding assessment tools.
The objectives of this study were to validate the Patient Empowerment Strategies Questionnaire (PES-Q) in a Greek sample and to study its psychometric properties in a sample of patients diagnosed with chronic insomnia.
This is a validation of the PES-Q in Attikon General Hospital, School of Medicine, National and Kapodistrian University of Athens. The questionnaire was administered to 93 subjects aged between 18 and 85 years (mean age ± SD: 54.7 ± 15.2, 28% males).
The criterion validity of the questionnaire was tested with the use of four specific criteria: the Athens Insomnia Scale, the Pittsburg questionnaire (Pittsburg Sleep Quality Index), the Depression, Anxiety and Stress Scale, and the Self-Esteem Scale.
According to factor analysis results, the structure of the original scale was confirmed by the presence of one main factor in the Greek sample, explaining 40.1% of the variance of PES-Q queries. The questionnaire showed satisfactory reliability (Cronbach’s α = 0.887). The results of the current study suggest that the PES-Q may be used as an accurate psychometric instrument for the purposes of chronic insomnia. Future research should examine the psychometric qualities of the PES-Q Greek version in a larger sample.
To validate digitally displayed photographic portion-size estimation aids (PSEA) against a weighed meal record and compare findings with an atlas of printed photographic PSEA and actual prepared-food PSEA in a low-income country.
Participants served themselves water and five prepared foods, which were weighed separately before the meal and again after the meal to measure any leftovers. Participants returned the following day and completed a meal recall. They estimated the quantities of foods consumed three times using the different PSEA in a randomized order.
Two urban and two rural communities in southern Malawi.
Women (n 300) aged 18–45 years, equally divided by urban/rural residence and years of education (≤4 years and ≥5 years).
Responses for digital and printed PSEA were highly correlated (>91 % agreement for all foods, Cohen’s κw = 0·78–0·93). Overall, at the individual level, digital and actual-food PSEA had a similar level of agreement with the weighed meal record. At the group level, the proportion of participants who estimated within 20 % of the weighed grams of food consumed ranged by type of food from 30 to 45 % for digital PSEA and 40–56 % for actual-food PSEA. Digital PSEA consistently underestimated grams and nutrients across foods, whereas actual-food PSEA provided a mix of under- and overestimates that balanced each other to produce accurate mean energy and nutrient intake estimates. Results did not differ by urban and rural location or participant education level.
Digital PSEA require further testing in low-income settings to improve accuracy of estimations.
For patients’ entire families, it can be challenging to live with cancer during the palliative stage. However, a sense of coherence buffers stress and could help health professionals identify families that require support. Therefore, the short version of the Family Sense of Coherence Scale (FSOC-S) was translated, culturally adapted, and validated in a Swedish sample.
Translation and cross-cultural adaptation of the FSOC-S into Swedish was conducted in accordance with the World Health Organization's Process for Translation and Adaptation of Research Instruments guidelines. Participants were recruited from two oncology clinics and two palliative centers in Sweden.
Content validity was supported by experts (n = 7), persons with cancer (n = 179), and family members (n = 165). Homogeneity among items was satisfactory for persons with cancer and family members (item-total correlations were 0.45‒0.70 and 0.55‒0.72, respectively) as well as internal consistency (ordinal alpha = 0.91 and 0.91, respectively). Factor analyses supported unidimensionality. FSOC-S correlated (rs > 0.3) with hope, anxiety, and symptoms of depression, which supported convergent validity. The test-retest reliability for items ranged between fair and good (kw = 0.37‒0.61).
Significance of Results
The FSOC-S has satisfactory measurement properties to assess family sense of coherence in persons with cancer and their family members. FSOC-S could be used to identify family members who experience low levels of perceived family sense of coherence which provides health care professionals with insight into families’ needs and ability to live with cancer in the palliative stage.
Online self-reported 24-h dietary recall systems promise increased feasibility of dietary assessment. Comparison against interviewer-led recalls established their convergent validity; however, reliability and criterion-validity information is lacking. The validity of energy intakes (EI) reported using Intake24, an online 24-h recall system, was assessed against concurrent measurement of total energy expenditure (TEE) using doubly labelled water in ninety-eight UK adults (40–65 years). Accuracy and precision of EI were assessed using correlation and Bland–Altman analysis. Test–retest reliability of energy and nutrient intakes was assessed using data from three further UK studies where participants (11–88 years) completed Intake24 at least four times; reliability was assessed using intra-class correlations (ICC). Compared with TEE, participants under-reported EI by 25 % (95 % limits of agreement −73 % to +68 %) in the first recall, 22 % (−61 % to +41 %) for average of first two, and 25 % (−60 % to +28 %) for first three recalls. Correlations between EI and TEE were 0·31 (first), 0·47 (first two) and 0·39 (first three recalls), respectively. ICC for a single recall was 0·35 for EI and ranged from 0·31 for Fe to 0·43 for non-milk extrinsic sugars (NMES). Considering pairs of recalls (first two v. third and fourth recalls), ICC was 0·52 for EI and ranged from 0·37 for fat to 0·63 for NMES. EI reported with Intake24 was moderately correlated with objectively measured TEE and underestimated on average to the same extent as seen with interviewer-led 24-h recalls and estimated weight food diaries. Online 24-h recall systems may offer low-cost, low-burden alternatives for collecting dietary information.
To evaluate differences in children’s eating behaviour in relation to their weight status.
Prospective, cross-sectional study. Anthropometric measures were taken and age- and sex-adjusted BMI percentiles and Z-scores were calculated according to the Centers for Disease Control and Prevention recommendations to assess weight status. Parents completed a questionnaire which included demographic data and the Children’s Eating Behaviour Questionnaire (CEBQ) to assess eating behaviour.
Tuzla Canton, Bosnia and Herzegovina (September 2016–September 2017).
Male and female children aged 3–10 years and one of their parents.
The study sample comprised 2500 children; 6·8 % of them were underweight and 14·4 % were overweight, while there were 14·8 % obese children and 64·0 % had normal weight. The factor analysis of CEBQ revealed an eight-factor solution. Significant differences in CEBQ subscale scores were found within BMI categories for all CEBQ subscales except Food Fussiness. On the other hand, child BMI Z-scores showed a linear increase with the ‘food approach’ subscales of the CEBQ, except the Desire to Drink subscale which was excluded from analysis, and a decrease with ‘food avoidant’ subscales.
The present study suggests that the CEBQ is valuable for identifying specific eating styles that are associated with weight status and can be seen as important and modifiable determinants implicated in the development and maintenance of overweight/obesity as well as underweight.
The aim of the present study was to assess the relative validity of a new web-based 24-h dietary recall (R24W) in terms of vegetable and fruit (VF) intake assessment using serum carotenoid concentrations as reference biomarkers. A total of seventy-four women and seventy-three men (mean age 47·5 (sd 13·3) years; mean BMI 25·5 (sd 4·4) kg/m2) completed the R24W four times to assess their VF intake. Serum carotenoids were obtained from 12-h fasted blood samples and measured by HPLC. Raw and de-attenuated partial Spearman's correlations were performed to determine how usual vegetable and/or fruit intake was associated with serum carotenoids. Relevant confounders were selected using a stepwise regression analysis. Finally, cross-classification was used to determine agreement between intake of VF and serum carotenoids. Intake of total dietary carotenoids was significantly associated (r 0·40; P < 0·01) with total serum carotenoids (without lycopene). Total VF intake was also associated with total serum carotenoid concentrations without lycopene (r 0·44; P < 0·01). HDL-cholesterol, waist circumference and age were identified as confounders in the association between total VF intake and total serum carotenoids (without lycopene). De-attenuated partial correlation adjusted for these confounders increased the associations between dietary carotenoids and total serum carotenoids without lycopene (r 0·49; P < 0·01) and between total VF intake and total serum carotenoids without lycopene (r 0·48; P < 0·01). Almost 80 % of respondents were classified in the same or the adjacent quartile for total VF intake and total serum carotenoids without lycopene, while less than 6 % were classified in the opposite quartile. Overall, these observations support the appropriateness of the R24W to assess the dietary intake of VF.
To evaluate the psychometric properties of the Brazilian version of the Shame and Stigma Scale (SSS) in a sample of patients with head and neck cancers (HNC).
This is a validation study carried out in a Brazilian cancer hospital. Patients over 18 years old who knew about their HNC diagnosis were consecutively recruited, answering the SSS, the Functional Assessment of Cancer Therapy (General and Head and Neck supplement) questionnaire, and the University of Washington Quality of Life Questionnaire. Internal consistency, test-retest procedure, convergent validity, and responsiveness analysis were the psychometric properties evaluated.
A total of 122 HNC patients were included. The SSS showed appropriate internal consistency (alphas ranging from 0.71 to 0.86), test-retest reliability (higher than 0.92 with exception of the “Regret domain”), and convergent validity. The responsiveness analysis with 38 patients was able to discriminate the scores before and after prosthetic procedures.
Significance of the Results
The Brazilian Portuguese version of the SSS may be considered a valid and reliable instrument for the evaluation of Brazilian patients with HNC. Future SSS validation studies are welcome in other developing countries in order to make cancer health providers aware of these negative feelings in their HNC patients.
Therapist validation in treatment is theorized to be related to positive outcomes (Linehan, 1993), including keeping patients in therapy longer.
We sought to evaluate the role of therapist validation from both therapists’ and clients’ perspectives as a predictor of drop-out from psychotherapy in three cognitive behavioural training clinics.
Clients in psychotherapy (n = 50; 80% female; 82% Caucasian) and their trainee therapists (n = 22; 68% female; 86% Caucasian) rated validation by the therapist at each of four early sessions of therapy.
After accounting for symptom severity, clients who reported greater therapist validation were less likely to drop out of treatment. Therapist ratings of their own validating behaviours were unrelated to client drop-out. Therapist experience moderated the relation between client-rated validation and drop-out, such that validation was unrelated to drop-out for more experienced therapists.
Assessing and attending to client perceptions of validation by the therapist early in treatment, with brief self-report inventories, can alert therapists to clients at greater risk of drop-out.
IUI is often the first intervention offered for unexplained or mild to moderate male infertility and appears to be a safe method to prevent HIV transmission. Pregnancy and delivery rates per cycle remained stable for years. Factors influencing IUI results and studies evaluating if first line IVF rather than IUI could be a better option for couples with unexplained or mild male infertility will be discussed.
Increased risks compared to spontaneous conceptions have been described. However, data on comparison with IVF is limited and points to similar or lower perinatal risks. Multiple pregnancies are responsible for most of perinatal morbidities and are dependent on the use and aggressiveness of ovarian stimulation. Cost efficiency appears to be influenced by the indication, associated medications and perinatal complications mainly related to multiple pregnancies. While currently IUI with ovarian stimulation seems cost-effective, further studies are needed to confirm it in settings with advanced ART techniques.
We evaluated the performance of an FFQ in estimating phytosterol intake against multiple 24-h dietary recalls (24HDR) using data from 1011 participants of the calibration sub-study of the Adventist Health Study-2 (AHS-2) cohort. Dietary assessments of phytosterol intake included a self-administered FFQ and six 24HDR and plasma sterols. Plasma sterols were determined using the GLC flame ionisation method. Validation of energy-adjusted phytosterol intake from the FFQ with 24HDR was conducted by calculating crude, unadjusted, partial and de-attenuated correlation coefficients (r) and cross-classification by race. On average, total phytosterol intake from the FFQ was 439·6 mg/d in blacks and 417·9 mg/d in whites. From the 24HDR, these were 295·6 mg/d in blacks and 351·4 mg/d in whites. Intake estimates of β-sitosterol, stigmasterol, other plant sterols and total phytosterols from the FFQ had moderate to strong correlations with estimates from 24HDR (r 0·41–0·73). Correlations were slightly higher in whites (r 0·42–0·73) than in blacks (r 0·41–0·67). FFQ estimates were poorly correlated with plasma sterols as well as 24HDR v. plasma sterols. We conclude that the AHS-2 FFQ provided reasonable estimates of phytosterol intake and may be used in future studies relating phytosterol intake and disease outcomes.
This study aimed to determine the cutoff and the specificity and sensitivity of the Emotion Thermometers (ET) in a Portuguese sample of cancer patients.
A total of 147 patients (mean age = 49.2; SD = 12.6) completed the ET, the Brief Symptom Inventory (BSI), and the Subjective Experiences of Illness Suffering Inventory. Data were collected in a cancer support institution and in a major hospital in the North of Portugal.
The optimal cutoff for the Anxiety Thermometer was 5v6 (until 5 and 6 or more), which identified 74% of the BSI-anxiety cases and 70% of noncases. The Depression Thermometer cutoff was 4v5 (until 4 and 5 or more), which identified 85% of BSI-depression cases and 82% of noncases. Cutoff for the Anger Thermometer was 4v5 (until 4 and 5 or more), which identified 83% of BSI-hostility cases and 73% of noncases; for the Distress Thermometer, the optimal cutoff was 4v5 (until 4 and 5 or more), which identified 84% of the suffering cases and 73% of noncases. Finally, for the Help Thermometer, it was 3v4 (until 3 and 4 or more), which helped to identify 93% of the suffering cases and 64% of noncases.
Significance of results
Results supported the Portuguese version of the ET as an important screening tool for identifying the emotional distress in cancer patients.
The Comprehensive Framework for Disaster Evaluation Typologies, developed in 2017 (CFDET 2017), aims to unify and facilitate agreement regarding the identification, structure, and relationships between various evaluation typologies found in the disaster setting. A peer-reviewed validation process sought input from international experts in the fields of disaster medicine, disaster/emergency management, humanitarian/development, and evaluation. This paper discusses the validation process, its results, and outcomes.
Previous frameworks, identified in the literature, lack validation and consistent terminology. To gain credibility and utility, this unique framework needed to be validated by international experts in the disaster setting.
A mixed methods approach was designed to validate the framework. An initial iterative process informed an online survey which used a combination of a five-point Likert scale and open-ended questions. Pre-determined consensus thresholds, informed by a targeted literature review, provided the validation criteria.
A sample of 33 experts from 11 countries responded to the validation process. Quantitative measures largely supported the elements and relationships of the framework, and strongly supported its value and usefulness for supporting, promoting, and undertaking evaluations, as well as its usefulness for teaching evaluation in the disaster setting. Qualitative input suggested opportunities to strengthen and enhance the framework. There were limited responses to better understand the barriers and enablers of undertaking disaster evaluations. A potential for self-selection bias of respondents may be a limitation of this study. The attainment of high consensus thresholds, however, provides confidence in the validity of the results.
For the first time, a framework of this nature has undergone a rigorous validation process by experts in three related disciplines at an international level. The modified framework, CFDET 2018, provides a unifying framework within which existing evaluation typologies can be structured. It gives evaluators confidence to choose an appropriate strategy for their particular evaluation in the disaster setting and facilitates consistency in reporting across the different phases of a disaster to better understand the process, outcomes, and impacts of the efficacy and efficiency of interventions. Future research could create a series of toolkits to support improved disaster evaluation processes and to evaluate the utility of the framework in the real-world setting.
The Language Experience and Proficiency Questionnaire (LEAP-Q) is a validated questionnaire tool for collecting self-reported proficiency and experience data from bilingual and multilingual speakers ages 14 to 80. It is available in over 20 languages, and can be administered in a digital, paper-and-pencil, and oral interview format. The LEAP-Q is used by researchers across various disciplines (Psychology, Neuroscience, Linguistics, Education, Communication Sciences & Disorders, etc.) to provide a comprehensive description of their bilingual participants, to substantiate a division of bilinguals into groups (e.g., early vs. late bilinguals), and to screen participants for adequate or threshold levels of language proficiency. Best practices for using the LEAP-Q include administration of the full questionnaire, consideration of acquisition and history of language use together with self-ratings of proficiency, and supplementation of self-reported data with objective language measures whenever possible. The LEAP-Q can be downloaded at no cost at https://bilingualism.northwestern.edu/leapq/.
The present study tested the validity of a digital image-capture measure of food consumption suitable for use in busy school cafeterias.
Lunches were photographed pre- and post-consumption, and food items were weighed pre- and post-consumption for comparison.
A small research team recorded children’s lunchtime consumption in one primary and one secondary school over seven working days.
A primary-school sample of 121 children from North Wales and a secondary-school sample of 124 children from the West Midlands, UK, were utilised. Nineteen children were excluded because of incomplete data, leaving a final sample of 239 participants.
Results indicated that (i) consumption estimates based on images were accurate, yielding only small differences between the weight- and image-based judgements (median bias=0·15–1·64 g, equating to 0·45–3·42 % of consumed weight) and (ii) good levels of inter-rater agreement were achieved, ranging from moderate to near perfect (Cohen’s κ=0·535–0·819). This confirmed that consumption estimates derived from digital images were accurate and could be used in lieu of objective weighed measures.
Our protocol minimised disruption to daily lunchtime routine, kept the attrition low, and enabled better agreement between measures and raters than was the case in the existing literature. Accurate measurements are a necessary tool for all those engaged in nutrition research, intervention evaluation, prevention and public health work. We conclude that our simple and practical method of assessment could be used with children across a range of settings, ages and lunch types.