Conceptualization of the term "ecological validity" in neuropsychological research on executive function assessment: a systematic review and call to action.

OBJECTIVE: "Ecological validity" (EV) is classically defined as test's ability to predict real-world functioning, either alone or together with test's similarity to real-world tasks. In neuropsychological literature on assessment of executive functions (EF), EV is conceptualized inconsistently, leading to misconceptions about the utility of tests. The goal of this systematic review was to examine how EV is conceptualized in studies of EF tests described as ecologically valid. METHOD: MEDLINE and PsychINFO Databases were searched. PRISMA guidelines were observed. After applying inclusion and exclusion criteria, this search yielded 90 articles. Deductive content analysis was employed to determine how the term EV was used. RESULTS: About 1/3 of the studies conceptualized EV as the test's ability to predict functional outcomes, 1/3 as both the ability to predict functional outcome and similarity to real-world tasks, and 1/3 were either unclear about the meaning of the term or relied on notions unrelated to classical definitions (e.g., similarity to real-world tasks alone, association with other tests, or the ability to discriminate between populations). CONCLUSIONS: Conceptualizations of the term EV in literature on EF assessment vary grossly, subsuming the notions of criterion, construct, and face validity, as well as sensitivity/specificity. Such inconsistency makes it difficult to interpret clinical utility of tests that are described as ecologically valid. We call on the field to require that, at minimum, the term EV be clearly defined in all publications, or replaced with more concrete terminology (e.g., criterion validity).

Content and face validity of Workplace COVID-19 Knowledge & Stigma Scale (WoCKSS).

BACKGROUND: The COVID-19 pandemic has led to fear, rumours, and stigma, particularly against those infected with the virus. In Malaysia, the manufacturing industry is particularly vulnerable to COVID-19 clusters, making it critical to assess stigma attitudes among workers. To address this issue, The Workplace COVID-19 Knowledge & Stigma Scale (WoCKSS) was developed specifically for use in the manufacturing industry which served as the sample population for testing this scale. It was developed in the Malay language to ensure alignment with the local context. This study examines the content and face validity of WoCKSS, which can help assess the level of knowledge and stigma associated with COVID-19 among workers. METHODS: The WoCKSS was developed with 20 and 31 items for knowledge and stigma domains, respectively, based on an extensive review of COVID-19 literature. Content validation was conducted by four experts using a content validation form to assess the relevancy of each item to the intended construct. Content Validity Index (CVI) was calculated to measure the agreement between the experts on the relevance of each item to the intended construct. Face validation was then conducted by randomly selecting 10 respondents from the manufacturing industry, who rated the clarity and comprehension of each item using a face validation form. The Item Face Validity Index (I-FVI) was calculated to determine the clarity and comprehension of each question, and only items with an I-FVI ≥ 0.83 were retained. RESULTS: The WoCKSS achieved excellent content validity in both knowledge and stigma domains. Only 19 items from the knowledge domain and 24 items from the stigma domain were retained after CVI analysis. All retained items received a CVI score of 1.00, indicating perfect agreement among the experts. FVI analysis resulted in 17 items for the knowledge domain and 22 items for the stigma domain. The knowledge domain achieved a high level of agreement among respondents, with a mean I-FVI of 0.91 and a S-FVI/UA of 0.89. The stigma domain also showed high agreement, with a mean I-FVI of 0.99 and a S-FVI/UA of 0.86. CONCLUSION: In conclusion, the WoCKSS demonstrated high content and face validity. However, further testing on a larger sample size is required to establish its construct validity and reliability.

Assessment of multi-professional primary healthcare center quality by patients with multimorbidity.

BACKGROUND: The main aim of this study was to build an item bank for assessing the care quality of multi-professional healthcare centers (MPHCC) from the perspective of patients with multimorbidity. This study was part of the QUALSOPRIM (QUALité des SOins PRIMaires; primary healthcare quality) research project to create a psychometrically robust self-administered questionnaire to assess healthcare quality. METHODS: First, twelve experts built an item bank using data from a previous qualitative work and a systematic literature review. Second, the validity of each item was assessed in a sample of patients. Adult patients with multimorbidity were recruited from six French MPHCC. Items were assessed based on ceiling effects, the level of missing or neutral responses and patient feedback. Patient feedback was recorded after the item bank completion. Based on results, items were validated, improved, or removed during expert meetings. In case of disagreement the Delphi method was used to reach consensus. RESULTS: The study sample included 209 outpatients. The most frequent medical conditions were cardiovascular risk factors, cardiovascular diseases and rheumatological conditions. In total, a bank of 109 items classified in nine domains was built. The validity assessment led to the removal of 34 items. Retained items explored a variety of topics related to care quality: availability, accessibility, premises' layout and building, technical care, expertise, organization, relationships with caregivers and communication, involvement and personal relationships. CONCLUSIONS: This study allowed cross-validation of a bank of 75 items, leading to a complete picture of the patient perception of care quality items. Overall, patients were generally satisfied with their care at the MPHCC. Nonetheless, there were still numerous items on subjects for which patients' satisfaction could be improved.

Feasibility and face validity of two patient reported outcome measures for nausea: Preferences of children with cancer.

PURPOSE: To optimize recognition and management of nausea in children with cancer using patient reported outcome measures (PROMs) and to identify preferences of children with cancer regarding two validated tools: the Baxter Retching Faces (BARF) scale and the Pediatric Nausea Assessment Tool (PeNAT). DESIGN AND METHODS: This quantitative descriptive cross-sectional study (n = 34) used bespoke questionnaires to measure feasibility and face validity of the BARF and the PeNAT. Feasibility included the items: understanding, ease of use, and communication. Face validity was studied in terms of the degree in which the faces of both PROMs corresponded with children's feelings of nausea. A descriptive and comparative analysis of the data was performed. RESULTS: Both the BARF and the PeNAT were rated by the children as feasible, and no significant differences were found. However, regarding the item communication, the PeNAT did not reach the cut-off value (≥80% of all children scored neutral, agree or totally agree on the Likert scale). Regarding face validity, only the BARF reached the cut-off value and corresponded significantly better with children's feelings of nausea than the PeNAT. CONCLUSION: According to children with cancer, only the BARF is both feasible and meets criteria for face validity. Therefore, the BARF is recommended as a PROM for reporting nausea in children with cancer. However, possible differences between age groups should be taken into account for future research. PRACTICE IMPLICATIONS: This study will help health care professionals in making a patient-centered and informed choice when using a PROM for measuring nausea in children with cancer.

The bruxism screener (BruxScreen): Development, pilot testing and face validity.

BACKGROUND: To assess awake and sleep bruxism, the Standardised Tool for the Assessment of Bruxism (STAB) is currently being developed. The STAB will be a comprehensive tool for the detailed assessment of bruxism behaviour itself as well as of its possible consequences, causes, and comorbid conditions. OBJECTIVE: Since the STAB cannot fully meet the 'A4 principle' for a bruxism assessment tool, i.e., being Accurate (reliable and valid), Applicable (feasible), Affordable (cost-effective), and Accessible (suitable for everyday clinical use), the Bruxism Screener (BruxScreen) has been developed to be used in large-scale epidemiological research projects and, especially, in general, dental practices. METHODS: The BruxScreen consists of two parts: a questionnaire (BruxScreen-Q) to be completed by patients, and a clinical assessment form (BruxScreen-C) to be completed by dentists. RESULTS: This paper describes the development of the BruxScreen and provides the outcomes of the pilot testing phase and the face validity assessment (i.e. that the first impressions of the tool indicate that it adequately reflects the construct to be measured). CONCLUSION: The resulting BruxScreen is considered ready for more profound psychometric testing in the general dental setting.

Construct, Face, and Predictive Validity of Parkinson's Disease Rodent Models.

Parkinson's disease (PD) is the second most common neurodegenerative disease globally. Current drugs only alleviate symptoms without halting disease progression, making rodent models essential for researching new therapies and understanding the disease better. However, selecting the right model is challenging due to the numerous models and protocols available. Key factors in model selection include construct, face, and predictive validity. Construct validity ensures the model replicates pathological changes seen in human PD, focusing on dopaminergic neurodegeneration and a-synuclein aggregation. Face validity ensures the model's symptoms mirror those in humans, primarily reproducing motor and non-motor symptoms. Predictive validity assesses if treatment responses in animals will reflect those in humans, typically involving classical pharmacotherapies and surgical procedures. This review highlights the primary characteristics of PD and how these characteristics are validated experimentally according to the three criteria. Additionally, it serves as a valuable tool for researchers in selecting the most appropriate animal model based on established validation criteria.

Content, face, and construct validity of the Irritable Bowel Syndrome Quality of Life (IBS-QOL) as a measure of bowel-related quality of life in spinal cord injury.

INTRODUCTION: Neurogenic bowel dysfunction is commonly encountered after a spinal cord injury (SCI), leading to a tremendous impact on quality of life (QOL). The neurogenic bowel dysfunction score (NBDS) is commonly used to measure the severity of bowel dysfunction and predict QOL. However, there is no comprehensive instrument to assess bowel-specific QOL for SCI patients. Instead, the Irritable Bowel Syndrome-Quality of Life (IBS-QOL) questionnaire evaluates the impact of bowel dysfunction on several aspects of QOL, although this questionnaire has not been validated for the SCI population. Motivated by the compelling need of instruments to accurately evaluate the QOL in patients who develope NBD after SCI, we aimed to assess the construct, content, and face validity of IBS-QOL in this population. METHODS: Adult SCI patients with at least 3 months after their injury were recruited from the outpatient clinic of a national rehabilitation hospital. Patients completed the NBDS and IBS-QOL via telephone interview or paper survey in the clinic. Content and face validity were assessed via interviews with professionals with expertise in providing chronic care for SCI, as well as a subgroup of patients. Construct validity was assessed using the hypotheses testing method. Internal consistency was assessed using Cronbach's ⍺. Factor analysis was performed to assess the dimensionality of the IBS-QOL in the SCI population. RESULTS: A total of 106 patients with a median age of 45.5 years (interquartile range: 21-79) participated in the study. The majority of the sample were men (n = 82, 77%) and had endured thoracolumbar injuries (n = 74, 71.2%). Twelve patients (seven English- and five Spanish speakers) and six professionals took part in content/face validation interviews. The median IBS-QOL total score was 15.91/100 (interquartile range: 4.55-33.14). IBS-QOL differentiated the subgroups of patients with severe bowel symptoms in terms of uneasiness, sweating, or headaches during bowel emptying (p = 0.0003), time spent on bowel emptying (p = 0.0065), flatus incontinence (p = 0.0076), and overall satisfaction with bowel function (p < 0.001), demonstrating its adequate construct validity. Interviews with the patients and professionals supported the comprehensiveness, comprehensibility, and relevance of IBS-QOL for assessment of bowel-related QOL in the SCI population. Item-level analysis of professional responses showed that 97% of questions were relevant to the construct and population of interest. Internal consistency analysis yielded a Cronbach's ⍺ of 0.9684. Exploratory factor analysis yielded six underlying factors which cumulatively accounted for 72.21% of the total variance, reflecting the dimensionality of bowel-related QOL in SCI population. DISCUSSION: IBS-QOL questionnaire is a comprehensive measure of bowel-related QOL which encompasses the concerns of SCI patients. Our findings support the content, face and construct validity of IBS-QOL as a measure of bowel-related QOL in SCI. Further studies are warranted to assess the reliability and responsiveness of IBS-QOL, and to evaluate its performance across different patient populations.

Development of the Malay Language of understanding, attitude, practice and health literacy questionnaire on COVID-19 (MUAPHQ C-19): content validity & face validity analysis.

OBJECTIVE: This study aimed to assess the content and face validity index of the development of the understanding, attitude, practice and health literacy questionnaire on COVID-19 (MUAPHQ C-19) in the Malay language. METHODS: The development of the MUAPHQ C-19 was conducted in two stages. Stage I resulted in the generation of the instrument's items (development), and stage II resulted in the performance of the instrument's items (judgement and quantification). Six-panel experts related to the study field and ten general public participated to evaluate the validity of the MUAPHQ C-19. The content validity index (CVI), content validity ratio (CVR) and face validity index (FVI) were analysed using Microsoft Excel. RESULTS: There were 54 items and four domains, namely the understanding, attitude, practice and health literacy towards COVID-19, identified in the MUAPHQ C-19 (Version 1.0). The scale-level CVI (S-CVI/Ave) for every domain was above 0.9, which is considered acceptable. The CVR for all items was above 0.7, except for one item in the health literacy domain. Ten items were revised to improve the item's clarity, and two items were deleted due to the low CVR value and redundancy, respectively. The I-FVI exceeded the cut-off value of 0.83 except for five items from the attitude domain and four from the practice domains. Thus, seven of these items were revised to increase the clarity of items, while another two were deleted due to low I-FVI scores. Otherwise, the S-FVI/Ave for every domain exceeded the cut-off point of 0.9, which is considered acceptable. Thus, 50-item MUAPHQ C-19 (Version 3.0) was generated following the content and face validity analysis. CONCLUSIONS: The questionnaire development, content validity, and face validity process are lengthy and iterative. The assessment of the instruments' items by the content experts and the respondents is essential to guarantee the instrument's validity. Our content and face validity study has finalised the MUAPHQ C-19 version that is ready for the next phase of questionnaire validation, using Exploratory and Confirmatory Factor Analysis.

Generation, Selection, and Face Validation of Items for a New Generic Measure of Quality of Life: The EQ-HWB.

OBJECTIVES: This article aims to describe the generation and selection of items (stage 2) and face validation (stage 3) of a large international (multilingual) project to develop a new generic measure, the EQ-HWB (EQ Health and Wellbeing), for use in economic evaluation across health, social care, and public health to estimate quality-adjusted life-years. METHODS: Items from commonly used generic, carer, social care, and mental health quality of life measures were mapped onto domains or subdomains identified from a literature review. Potential terms and items were reviewed and refined to ensure coverage of the construct of the domains/subdomain (stage 2). Input on the potential item pool, response options, and recall period was sought from 3 key stakeholder groups. The pool of candidate items was tested in qualitative interviews with potential future users in an international face validation study (stage 3). RESULTS: Stage 2 resulted in the generation of 687 items. Predetermined selection criteria were applied by the research team resulting in 598 items being dropped, leaving 89 items that were reviewed by key stakeholder groups. Face validation (stage 3) tested 97 draft items and 4 response scales. A total of 47 items were retained and 14 were modified, whereas 3 were added to the candidate pool of items. This resulted in a 64-item set. CONCLUSIONS: This international multiculture, multilingual study with a common methodology identified many items that performed well across all countries. These were taken to the psychometric testing along with modified and new items for the EQ-HWB.

The Development of a New International Generic Measure (EQ-HWB): Face Validity and Psychometric Stages in Argentina.

OBJECTIVES: This study aimed to present the face validity and psychometric stages performed in Spanish in Argentina, the only Spanish-speaking country of an international collaboration that undertook the construction of a new measure that can be used in economic evaluation across health, social care, and public health, the EQ EQ-HWB (EQ Health and Wellbeing). We also explored the relationship among 3-level version EQ-5D (EQ-5D-3L), 5-level version EQ-5D (EQ-5D-5L), and EQ-HWB. METHODS: Face validity was based on semistructured face to face interviews of a purposive sample to explore translatability of language and concepts of 97 candidate items, translated into Argentina Spanish. The psychometric evaluation using an online panel assessed the psychometric properties of 64 items that were carried forward (floor and ceiling effects, item correlations, known-group differences in relevant prespecified subgroups by the international and local teams, exploratory and confirmatory factor analysis, and item response theory). EQ-5D-3L, EQ-5D-5L, and EQ-HWB correlations were explored. RESULTS: In the face validity stage, 24 interviews with carers, general public, patients, and users of social services were included. Most items showed adequate face validity. In the psychometric assessment, 497 participants were recruited (64% reporting a long-term health condition). Most of the items showed adequate psychometrics in an Argentinian context. EQ-5D-3L and EQ-5D-5L had strong correlations, and EQ-HWB was moderately correlated to EQ visual analog scale. The Argentina team recommended 23 of the final 25 items. CONCLUSIONS: The assessment of Spanish items contributed to the overall development of EQ-HWB and helped inform the design of an internationally relevant 25-item and a short 9-item measure intended to be used in economic evaluations.

Evaluation of simulation models in neurosurgical training according to face, content, and construct validity: a systematic review.

BACKGROUND: Neurosurgical training has been traditionally based on an apprenticeship model. However, restrictions on clinical exposure reduce trainees' operative experience. Simulation models may allow for a more efficient, feasible, and time-effective acquisition of skills. Our objectives were to use face, content, and construct validity to review the use of simulation models in neurosurgical education. METHODS: PubMed, Web of Science, and Scopus were queried for eligible studies. After excluding duplicates, 1204 studies were screened. Eighteen studies were included in the final review. RESULTS: Neurosurgical skills assessed included aneurysm clipping (n = 6), craniotomy and burr hole drilling (n = 2), tumour resection (n = 4), and vessel suturing (n = 3). All studies assessed face validity, 11 assessed content, and 6 assessed construct validity. Animal models (n = 5), synthetic models (n = 7), and VR models (n = 6) were assessed. In face validation, all studies rated visual realism favourably, but haptic realism was key limitation. The synthetic models ranked a high median tactile realism (4 out of 5) compared to other models. Assessment of content validity showed positive findings for anatomical and procedural education, but the models provided more benefit to the novice than the experienced group. The cadaver models were perceived to be the most anatomically realistic by study participants. Construct validity showed a statistically significant proficiency increase among the junior group compared to the senior group across all modalities. CONCLUSION: Our review highlights evidence on the feasibility of implementing simulation models in neurosurgical training. Studies should include predictive validity to assess future skill on an individual on whom the same procedure will be administered. This study shows that future neurosurgical training systems call for surgical simulation and objectively validated models.

A quantitative test of the face validity of behavior-change messages based on the Brazilian Dietary Guidelines.

BACKGROUND: Implementation science has scant evidence of how dietary guidelines can be developed into actionable behavior-change messages and even less evidence on their motivating potential and perceived effect on behavior. This may explain the widening gap between nutrition science and individual behavior and the low uptake of dietary recommendations by the population for which they are intended. This study aimed to: (i) assess participant receptivity and acceptance of behavior-change messages; (ii) determine if the behavior-change strategies used in the messages and the main theme they relayed influenced participant evaluation of the messages; (iii) explore if evaluations varied by participants' stage of behavior-change; and (iv) elucidate reasons for non-compliance with the messages. METHODS: An online survey was used to test the face validity and participant receptivity of 28 behavior-change messages, among a diverse sample of 2400 adult Brazilians. Participants' understanding of the messages, message likeability and convincingness, and the probability that participants would change behavior in accordance with the message were measured, along with reasons for non-compliance. RESULTS: The mean overall scores suggested that participants liked the messages, understood them, and found them convincing. As expected, the probability of complying with the messages scored lower compared to other study outcomes. Messages about shopping practices, cooking practices, and planning and organization performed better than those on other themes. Participants were more receptive to messages that included behavior-change strategies like goals, social identity, and pleasure, however, the probability of compliance was higher for messages with constructs that emphasized health and cost consequences. Participants trying to change their diet or seeking resources to support healthier dietary choices had greater engagement with and receptivity to the messages. Time and effort, and high costs associated with making healthy changes, were barriers to compliance. CONCLUSIONS: Messages may help improve individual understanding, stimulate interest in a topic and get participants engaged, particularly if messages are goal-oriented and highlight the pleasure and collective identity of these food-related behaviors. However, messages stop short of addressing the structural, social, and economic barriers to healthy diets. These aspects will need to be targeted through legislative action for sustainable behavior change.

How to develop a condition-specific PROM.

Developing new patient-reported outcome measures (PROMs) for application in clinical studies can be necessary if an adequate PROM does not exist. For adequate measurement, it is essential that the PROM has face validity (ie, is perceived to be relevant by clinicians and researchers) and has high content validity (ie, content relevance and content coverage for the targeted patient group). The steps needed to create PROMs that possess face and content validity for a specific condition are described in this paper. Face validity is achieved by item identification and generation through literature review. Content validity is confirmed through repetitive cognitive interviews of patients from the targeted patient group in order to generate a consensus-based pilot-version of the new PROM. This qualitative process ensures that items are appropriately worded, understandable, and minimizes doubts about how items should be answered. A practical example of this process is presented, which shows the development of the Knee Numeric-Entity Evaluation Score (KNEES-ACL), a condition-specific PROM for patients with deficiency of the anterior cruciate ligament (ACL).

Face and construct validity assessment of training models for intestinal anastomosis in low-birth-weight infants.

PURPOSE: It is difficult to perform intestinal anastomosis in low-birth-weight infants because the intestinal diameter is small and the discrepancy in diameter of the proximal and distal intestines is often large, but there has been no optimal-sized training model. Therefore, we developed a new intestinal anastomosis training model that imitated the size of the intestine in low-birth-weight infants, and evaluated its face and construct validity. METHODS: Two intestinal models were developed with crossMedical, Inc. using a hydrophilic acrylic material (wet model) or a polyurethane soft resin (dry model). The inner diameter of the simulated intestinal tract was 15 mm on the oral end and 6 mm on the anal end. Thirteen pediatric surgeons performed anastomosis and responded to the questionnaire. RESULTS: In the questionnaire, the wet model had significantly higher scores than the dry model in "appearance", "softness" and "usefulness for training". In the anastomotic results of the wet model, the anastomosis leak pressure was significantly correlated with the number of intestinal anastomotic experiences in low-birth-weight infants (correlation coefficient = 0.64, P = 0.035). CONCLUSIONS: The wet-type intestinal anastomosis model showed good face validity. Its leak pressure had a significant correlation with clinical experience; thus, construct validity was demonstrated.

Patient-reported outcome measures for patients with hand-specific impairments-A scoping review.

BACKGROUND: Patient-reported outcome measures (PROMs) are increasingly used to provide evidence for treatment effects and to guide rehabilitation. To our knowledge, no disease-specific PROM exists for the assessment of patients with flexor tendon lesions of the hand. We believe that PROMs used to assess hand function, regardless of diagnosis, contain relevant items for patients with flexor tendon lesions of the hand. PURPOSE: The aim of our study was to identify and collect items from pre-existing PROMs used by clinical experts to assess the health status and function in patients with reduced hand function. STUDY DESIGN: A scoping review searching for PROMs with hand-specific content was conducted to ensure face validity. As these items are assumed to have been through an evaluation process by the clinical specialists, they have the advantage and likelihood of being useful. METHODS: We searched five bibliographic databases. All PROMs with hand-specific content used to assess hand function were considered for inclusion. Questionnaires written in English, Danish, Swedish, and Norwegian were included. An analysis of content redundancy was conducted, and items were grouped according to The World Health Organization's International Classification of Functioning, Disability and Health. RESULTS: Seventy-three PROMs were included with a total of 1,582 items. The majority of the items were redundant across measurement instruments, and redundant items were consolidated, resulting in 179 nonredundant items. All nonredundant items were classified according to the International Classification of Functioning, Disability and Health components. CONCLUSIONS: This review presents a collection of 179 items ensuring face validity for patients with hand-related disease/injury.

Quantifying Spatiotemporal Gait Parameters with HoloLens in Healthy Adults and People with Parkinson's Disease: Test-Retest Reliability, Concurrent Validity, and Face Validity.

Microsoft's HoloLens, a mixed-reality headset, provides, besides holograms, rich position data of the head, which can be used to quantify what the wearer is doing (e.g., walking) and to parameterize such acts (e.g., speed). The aim of the current study is to determine test-retest reliability, concurrent validity, and face validity of HoloLens 1 for quantifying spatiotemporal gait parameters. This was done in a group of 23 healthy young adults (mean age 21 years) walking at slow, comfortable, and fast speeds, as well as in a group of 24 people with Parkinson's disease (mean age 67 years) walking at comfortable speed. Walking was concurrently measured with HoloLens 1 and a previously validated markerless reference motion-registration system. We comprehensively evaluated HoloLens 1 for parameterizing walking (i.e., walking speed, step length and cadence) in terms of test-retest reliability (i.e., consistency over repetitions) and concurrent validity (i.e., between-systems agreement), using the intraclass correlation coefficient (ICC) and Bland-Altman's bias and limits of agreement. Test-retest reliability and between-systems agreement were excellent for walking speed (ICC ≥ 0.861), step length (ICC ≥ 0.884), and cadence (ICC ≥ 0.765), with narrower between-systems than over-repetitions limits of agreement. Face validity was demonstrated with significantly different walking speeds, step lengths and cadences over walking-speed conditions. To conclude, walking speed, step length, and cadence can be reliably and validly quantified from the position data of the wearable HoloLens 1 measurement system, not only for a broad range of speeds in healthy young adults, but also for self-selected comfortable speed in people with Parkinson's disease.

Rationale, Relevance, and Limits of Stress-Induced Psychopathology in Rodents as Models for Psychiatry Research: An Introductory Overview.

Emotional and cognitive information processing represent higher-order brain functions. They require coordinated interaction of specialized brain areas via a complex spatial and temporal equilibrium among neuronal cell-autonomous, circuitry, and network mechanisms. The delicate balance can be corrupted by stressful experiences, increasing the risk of developing psychopathologies in vulnerable individuals. Neuropsychiatric disorders affect twenty percent of the western world population, but therapies are still not effective for some patients. Elusive knowledge of molecular pathomechanisms and scarcity of objective biomarkers in humans present complex challenges, while the adoption of rodent models helps to improve our understanding of disease correlate and aids the search for novel pharmacological targets. Stress administration represents a strategy to induce, trace, and modify molecular and behavioral endophenotypes of mood disorders in animals. However, a mouse or rat model will only display one or a few endophenotypes of a specific human psychopathology, which cannot be in any case recapitulated as a whole. To override this issue, shared criteria have been adopted to deconstruct neuropsychiatric disorders, i.e., depression, into specific behavioral aspects, and inherent neurobiological substrates, also recognizable in lower mammals. In this work, we provide a rationale for rodent models of stress administration. In particular, comparing each rodent model with a real-life human traumatic experience, we intend to suggest an introductive guide to better comprehend and interpret these paradigms.

Development and face validation of a virtual camera navigation task trainer.

BACKGROUND: The fundamentals of laparoscopic surgery (FLS) trainer box, which is now established as a standard for evaluating minimally invasive surgical skills, consists of five tasks: peg transfer, pattern cutting, ligation, intra- and extracorporeal suturing. Virtual simulators of these tasks have been developed and validated as part of the Virtual Basic Laparoscopic Skill Trainer (VBLaST) (Arikatla et al. in Int J Med Robot Comput Assist Surg 10:344-355, 2014; Zhang et al. in Surg Endosc 27(10):3603-3615, 2013; Sankaranarayanan et al. in J Laparoendosc Adv Surg Tech 20(2):153-157, 2010; Qi et al. J Biomed Inform 75:48-62, 2017). The virtual task trainers have many advantages including automatic real-time objective scoring, reduced costs, and eliminating human proctors. In this paper, we extend VBLaST by adding two camera navigation system tasks: (a) pattern matching and (b) path tracing. METHODS: A comprehensive camera navigation simulator with two virtual tasks, simplified and cheaper hardware interface (compared to the prior version of VBLaST), graphical user interface, and automated metrics has been designed and developed. Face validity of the system is tested with medical students and residents from the University at Buffalo's medical school. RESULTS: The subjects rated the simulator highly in all aspects including its usefulness in training to center the target and to teach sizing skills. The quality and usefulness of the force feedback scored the lowest at 2.62.

Construct, content and face validity of the eoSim laparoscopic simulator on advanced suturing tasks.

BACKGROUND: The purpose of this study was to validate the eoSim, an affordable and mobile inanimate laparoscopic simulator with instrument tracking capabilities, regarding face, content and construct validity on complex suturing tasks. METHODS: Participants recruited for this study were novices (no laparoscopic experience), target group for this training (surgical/gynaecologic/urologic residents, > 10 basic and < 20 advanced laparoscopic procedures) and experts (> 20 advanced laparoscopic procedures). Each participant performed the intracorporeal suturing exercise (Task 1), an upside down needle transfer (Task 2, developed for this study) and an anastomosis needle transfer (Task 3). Following, the participants completed a questionnaire regarding their demographics and opinion on the eoSim in terms of realism, didactic value and usability. Measured outcome parameters were time, distance, percentage of instrument tip off-screen, working area, speed, acceleration and smoothness. RESULTS: In total, 104 participants completed the study, of which 60 novices, 31 residents and 13 experts. Face and content validity results showed a mean positive opinion on realism (3.9 Task 1, 3.6 Task 2 and 3.7 Task 3), didactic value (4.0, 3.4 and 3.7, respectively) and usability (4.2. 3.7 and 4.0, respectively). There were no significant differences in these outcomes between the specified expertise groups. Construct validity results showed significant differences between experts, target group or novices for Task 1 in terms of time (means 339, 607 and 1224 s, respectively, p < 0.001) and distance (means 8.1, 15.6 and 21.7 m, respectively, p < 0.001). Task 2 showed significant differences between groups regarding time (p < 0.001), distance (p 0.003), off-screen (p < 0.001) and working area (p < 0.001). Task 3 showed significant differences between groups, after subanalyses, on total number of stitches (p < 0.001), time per stitch (p < 0.001) and distance per stitch (p < 0.001). CONCLUSIONS: The results of this study indicate that the eoSim is a potential meaningful and valuable simulator in the training of suturing tasks.

Validation of a virtual intracorporeal suturing simulator.

BACKGROUND: Intracorporeal suturing is one of the most important and difficult procedures in laparoscopic surgery. Practicing on a FLS trainer box is effective but requires large number of consumables, and the scoring is somewhat subjective and not immediate. A virtualbasic laparoscopic skill trainer (VBLaST©) was developed to simulate the five tasks of the FLS Trainer Box. The purpose of this study is to evaluate the face and content validity of the VBLaST suturing simulator (VBLaST-SS©). METHODS: Twenty-five medical students and residents completed an evaluation of the simulator. The participants were asked to perform the standard intracorporeal suturing task on both VBLaST-SS© and the traditional FLS box trainer. The performance scores on each system were calculated based on time (s), deviations to the black dots (mm), and incision gap (mm). The participants were then asked to finish a 13-item questionnaire with ratings from 1 (not realistic/useful) to 5 (very realistic/useful) regarding the face validity of the simulator. A Wilcoxon signed rank test was performed to identify differences in performance on the VBLaST-SS© compared to that of the traditional FLS box trainer. RESULTS: Three questions from the face validity questionnaire were excluded due to lack of response. Ratings to 8 of the remaining 10 questions (80%) averaged above 3.0 out of 5. Average intracorporeal suturing completion time on the VBLaST-SS© was 421 (SD = 168 s) seconds compared to 406 (175 s) seconds on the box trainer (p = 0.620). There was a significant difference between systems for the incision gap (p = 0.048). Deviation in needle insertion from the black dot was smaller for the box trainer than the virtual simulator (1.68 vs. 7.12, p < 0.001). CONCLUSION: Participants showed comparable performance on the VBLaST-SS© and traditional box trainer. Overall, the VBLaST-SS© system showed face validity and has the potential to support training for the suturing skills.