The following protocol describes the development of an assessment rubric for the purposes of measuring student learning outcomes. The process is applied to a doctoral nursing education program.
<ol>
<li>Introduction. Over the past two decades, teachers in healthcare education have been increasingly challenged to demonstrate through their educational programs how students are adequately prepared to function in complex service environments upon graduation (1, 2, 3,4, 5, 6). The concept of a student learning outcome measures is built on a desire to demonstrate through a measurement process how a student who successfully completes the learning process related to an area of knowledge. It is different from one who does not complete the same learning process. Grades alone do not demonstrate a student s mastery of the learning outcome but rather successful or unsuccessful achievement in response to a testing procedure at a point in time. Focus on grading at the expense of learning contributes to culture of testing rather than a culture of learning (7). Further, most testing procedures measure various concepts quantitatively that have been or are easily quantifiable. But what about those aspects of a science or skill that relate more to quality? How should educators measure these aspects? How should they be reflected in expected student learning outcomes? How should they be quantified so they can be appropriately measured? As a society we do not typically value what we cannot measure. This protocol provides a method for quantifying concepts and constructs in any discipline or skill through the use of what are known as "rubrics"(8). Once these concepts are quantified, they can then be measured, altered, and refined to demonstrate that knowledge has been attained by the student.</li>
<li>Structure. The following core concepts are visually defined as they relate to the assessment process. First, the development of the concept of a learning outcome is illustrated as follows (see Table 1). A learning outcome is the embodiment of the knowledge a student should have upon successful completion of the learning process related to some type of content. Learning outcomes should encompass knowledge that is grounded in measurement (intrinsically quantitative) and knowledge that is grounded in meaning (intrinsically qualitative). 
<ol>
<li>Structure-methodology. The next core concept of the assessment process is measurement methodology. Many educators confuse successful attainment of student learning outcomes with successful scores on a grade. Use of a grade as the only measurement methodology only reflects half of the potential assessment of the learning process. Perhaps this is best illustrated with the following question, which student has successfully grasped the learning outcome, the one who scores a 90% on an exam but cannot actualize the knowledge in a real-world situation versus the student who scores a 70% on the same exam and can actualize the knowledge when needed in a real-world situation? Grades alone provide a baseline, point in time measurement of knowledge verification and synthesis. They do not provide measurement of knowledge translation or application.</li>

<li>Structure-rubric Definition. Now that we understand the underpinnings of a learning outcome, we need to understand the best way to measure it. One good way is through the use of a matrix or assessment rubric. To properly develop a student learning outcome assessment rubric, one must first define what a rubric is. It is a scoring tool that, when properly constructed, allows the person using it to assess a piece of work using a defined set of criteria. Further, it provides a mechanism for defining quality by moving those "gut perceptions" into measurable phenomena. This has been shown to be of valuable to both teacher and learner especially in adult learning environments (9, 10).</li>

<li>Structure-rubric Composition. A rubric typically takes the physical shape of a grid with rows and columns. The rows delineate the various categories that define the concept or construct that you are trying to measure while the columns represent the varying degrees of each criteria you are measuring within each category. Table 2 provides the framework for a basic rubric.</li>

<li>Structure-rubric Overview. Once you understand what a rubric is and its function, you will need to think about what those aspects are of the concept or construct that you are trying to define. Table 3 provides an example of quantitative and qualitative concepts that could be applied to and measured in a learning outcomes assessment rubric.</li>
</ol>
</li>
<li>Process. The method for developing a successful rubric is grounded in the rubrics' ability to quickly and accurately measure the concepts or constructs you want to assess. In its most rudimentary state, it is the embodiment of the assessor s "gut feeling". Ideally, the measurement process should take into account quantitative aspects (things that are routinely, easily measured) and qualitative aspects (things that have meaning, not easily measured) and quantify both in the form of an assessment rubric.</li>

<li>Outcome. The desired outcome of developing and using an assessment rubric in the education process is to accurately measure student learning outcomes. The learning outcomes are measurable statements of what the teacher expects the student to be able to know, do, value, and think about, etc. upon completion of the course or program.</li>

<li>Application. Harden noted that the learning outcomes could be quantified in a way that allows for measurement of competencies necessary for practice in medicine (11). Well designed learning outcomes that measure performance in capstone courses have been shown to be an effective tool in correlating nursing education preparation for successful transition into practice (12). Properly constructed rubrics to assess learning outcomes are a core component of a well designed learning outcomes measurement program (13, 14). They have significant application in professional education programs where qualitative concepts are central to practice. This protocol is applied to a doctoral nursing education program for the purposes of demonstrating how to develop and use the assessment rubrics in course and program level evaluation of desired student learning outcomes.
<ol>
<li>Application-scenario. The Doctor of Nursing Practice (DNP) is a relatively new doctoral degree. It is the practice doctorate for nursing. It is the sister doctorate to other practice doctorates in healthcare such as the MD for physicians, the PharmD for pharmacists, and the PsyD for psychologists. At its core, is the expectation of graduates to be able to apply techniques such as synthesis and ethical decision making for the purposes of knowledge translation of research into nursing practice. The accreditation organization that certifies DNP programs requires that student learning outcomes measure the ability of the student to demonstrate these competencies previously described and others through application of skills and knowledge at a course and program level.</li>

<li>Application-learning Outcome Development. A teacher in the DNP program wishes to teach the knowledge and skills to students so they can demonstrate the ability to make ethical decisions. First, the teacher should use the following question to guide their creation of a learning outcome measure: What is it that I would want to say distinguishes a student who has grasped the concept of X than someone who has not grasped the concept of X. In this application, the concept is ethical decision making (see Table 1 for example).</li>

<li>Application-concept Development. Next, the teacher should write down these concepts that underpin the structure of whatever the outcome is that you are trying to measure. In our case, ethical decision making is what we want to assess. Again, Table 1 provides an example of these key concepts.</li>

<li>Application-quantitative Rubric Section Development. Third, the teacher should determine which of these concepts are intrinsically quantitative and may be measured as learning outcomes that encompass knowledge grounded through measurement. Table 4 represents the quantitative measurements of ethical decision making in a rubric that would measure our proposed learning outcome.</li>

<li>Application-qualitative Rubric Section Development. Fourth, the teacher should determine which of these concepts are intrinsically qualitative and may be measured as learning outcomes that encompass knowledge grounded in meaning. This section of rubric development may be implemented in one of two ways: either as a pure-qualitative descriptor section rubric or a quasi-qualitative descriptor section of the rubric. Once this section of the rubric is completed, the rubric is ready for use in assessing learning outcomes.</li>

<li>Application-qualitative Rubric Section Development Explicated. It is important to describe in additional detail the importance of clarifying how a teacher intends to measure the qualitative concepts of a learning outcome. The benefit of the pure-qualitative level rubric is the articulation of previously ill-defined or un-defined concepts into words which helps a teacher begin to qualify "gut" perceptions of student learning. However, the price of using the pure-qualitative approach to rubric measurement is the sacrifice of a more reliable assessment rubric because the application of the score is still in the eye of the assessor. Conversely, development of the concepts into a quasi-qualitative descriptor assessment facilitates reliable measurement when it is used by other assessors because it quantifies the concepts in a simple, objectively measurable format.</li>

<li>Application-rubric Testing. Now that the rubric is created, it is important to determine how it will be applied to measure the outcome. In general, learning outcome measurement rubrics are applied to learning activities in a course and have a grade component associated with them. The example in Table 5 shows how the rubric we just created is applied to an ethical decision-making exercise.</li>
</ol></li>
</ol>

<ol>
	<li>Facione, N. C., Facione, P. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+design+issues+for+evaluation+of+critical+thinking+in+nursing.">Assessment design issues for evaluation of critical thinking in nursing.</a> Holistic Nursing Practice. 10 (3), 41-52 (1996).</li><li>Epstein, R. M., Hundert, E. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Defining+and+assessing+professional+competence.">Defining and assessing professional competence.</a> Journal of the American Medical Association. 287 (2), 226-235 (2002).</li><li>Stone, S. L., Qualters, D. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Course-based+assessment:+Implementing+outcome+assessment+in+medical+education.">Course-based assessment: Implementing outcome assessment in medical education.</a> Academic Medicine. 73 (4), 397-401 (1998).</li><li>Boland, D. L., Laidig, J., Palomba, C. A., Banta, T. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessing+student+competence+in+accredited+disciplines:+Pioneering+approaches+to+assessment+in+higher+education.">Assessing student competence in accredited disciplines: Pioneering approaches to assessment in higher education.</a> Assessment of student learning in the discipline of nursing. , 71-94 (2001).</li><li>Epstein, R. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+in+medical+education.">Assessment in medical education.</a> New England Journal of Medicine. 356 (4), 387-396 (2007).</li><li>Halonen, J. S., Bosack, T., Clay, S., McCarthy, M., Dunn, D. S., Hill, G. W., McEntarffer, R., Mehrotra, C., Nesmith, R., Weaver, K. A., Whitlock, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+rubric+for+learning,+teaching,+and+assessing+scientific+inquiry+in+psychology.">A rubric for learning, teaching, and assessing scientific inquiry in psychology.</a> Teaching of Psychology. 30 (3), 196-208 (2003).</li><li>Birenbaum, M., Douchy, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Alternative in assessment of achievements, learning processes and prior knowledge. , (1996).</li><li>Knowles, M. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Modern Practice of Adult Education: From Pedagogy to Andragogy. , (1980).</li><li>Montgomery, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Authentic+Tasks+and+Rubrics:+Going+Beyond+Traditional+Assessments+in+College+Teaching.">Authentic Tasks and Rubrics: Going Beyond Traditional Assessments in College Teaching.</a> College Teaching. 50 (1), 34-39 (2002).</li><li>Wolf, K., Stevens, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+role+of+rubrics+in+advancing+and+assessing+student+learning.">The role of rubrics in advancing and assessing student learning.</a> Journal of Effective Teaching. 7 (1), 3-14 (2007).</li><li>Rebeschi, L. A. r. o. n. s. o. n., B, . <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+of+Nursing+Student's+Learning+Outcomes+and+Employment+Choice+after+the+Implementation+of+a+Senior+Capstone+Course.">Assessment of Nursing Student's Learning Outcomes and Employment Choice after the Implementation of a Senior Capstone Course.</a> International Journal of Nursing Education Scholarship. 6 (1), 1-15 (2009).</li><li>Bolton, F. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Rubrics+and+Adult+Learners:+Andragogy+and+Assessment.">Rubrics and Adult Learners: Andragogy and Assessment.</a> Assessment Update. 18 (3), 5-6 (2006).</li><li>Andrade, H. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Teaching+with+rubrics:+The+good,+the+bad,+and+the+ugly.">Teaching with rubrics: The good, the bad, and the ugly.</a> College Teaching. 53 (1), 27-30 (2005).</li></ol>

No conflicts of interest declared.

<ol>
<li>We have demonstrated what a learning outcome rubric is, how to construct one, and how to use it in the assessment of learning outcomes by applying it to a DNP education program. There are several key points that should be further described at this point.
<ol>
<li>Learning Outcome Rubrics versus Grading Rubrics. First, it is important to delineate the difference between a grading rubric and a learning outcomes rubric. A grading rubric is designed to help faculty assess what grade a student should receive based on their performance on a particular assignment and may or may not involve both quantitative and qualitative aspects, whereas a learning outcomes rubric is focused on helping faculty assess if a student learned all of the key and critical aspects of a concept or construct. The measurement of the learning outcome typically includes quantitative and qualitative aspects. Most importantly, an assignment that is graded is usually part of the overall assessment of a learning outcome.</li>
<li>Quantification of Intrinsically Qualitative Concepts. Once you understand the difference between a learning outcome rubric and a grading rubric, the most challenging part of constructing the learning outcome assessment rubric is determining to what level you wish to define the qualitative components. As mentioned previously, leaving the definition of components at a pure-qualitative level allows individual teacher freedom in assessing success or failure however; it is not usually reliable for use by other teaching faculty and as its definitions are often in the eye of the assessor. Further, this type of rubric also allows for student challenges of grading and outcomes assessment since again its interpretation may be in the eye of the beholder.</li>

<li>Course Level versus Program Level Learning Outcomes. Use of properly constructed learning outcome assessment rubrics allow for proper course level evaluation of teaching and learning processes and procedures. However, these rubrics are also applicable to program level evaluation of learning outcomes. For example, the results from a student cohort s scores on a particular learning outcome such as the one used in the application could be used to demonstrate the effectiveness of the teaching and learning process at an aggregate or program level. Then, these results can be used to help a program s faculty clearly track exactly which areas of the teaching process need to be modified as part of a learning program s continuous performance improvement process.</li>
</ol></li>
<li>Conclusion. We have attempted to explicate the concepts related to learning outcome rubrics; specifically, what they are and are not, how to construct them and how to use them. Further, we have applied the development of learning outcomes using a case study example of a DNP program. Learning outcome measurement represents an often misunderstood concept and misapplied process that can result in teaching faculty and student learner dissatisfaction. This presentation focused on demonstration of the development of a temporal knowledge through visual articulation of learning outcome measurement constructs.</li>
</ol>

using learning outcome measures to assess doctoral nursing education

Education programs at all levels must be able to demonstrate successful program outcomes. Grades alone do not represent a comprehensive measurement methodology for assessing student learning outcomes at either the course or program level. The development and application of assessment rubrics provides an unequivocal measurement methodology to ensure a quality learning experience by providing a foundation for improvement based on qualitative and quantitatively measurable, aggregate course and program outcomes.  Learning outcomes are the embodiment of the total learning experience and should incorporate assessment of both qualitative and quantitative program outcomes. The assessment of qualitative measures represents a challenge for educators in any level of a learning program. Nursing provides a unique challenge and opportunity as it is the application of science through the art of caring. Quantification of desired student learning outcomes may be enhanced through the development of assessment rubrics designed to measure quantitative and qualitative aspects of the nursing education and learning process. They provide a mechanism for uniform assessment by nursing faculty of concepts and constructs that are otherwise difficult to describe and measure. A protocol is presented and applied to a doctoral nursing education program with recommendations for application and transformation of the assessment rubric to other education programs. Through application of these specially designed rubrics, all aspects of an education program can be adequately assessed to provide information for program assessment that facilitates the closure of the gap between desired and actual student learning outcomes for any desired educational competency.

Watch this Scientific Journal Video about Using Learning Outcome Measures to assess Doctoral Nursing Education at JoVE.com

Using Learning Outcome Measures to assess Doctoral Nursing Education

The structure and process for measuring student learning outcomes through customizable assessment rubrics is discussed and applied to a doctoral nursing education program.

Education programs at all levels must be able to demonstrate successful program outcomes. Grades alone do not represent a comprehensive measurement ...

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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis

Each year, an estimated 785,000 Americans will have a new coronary attack, or acute coronary syndrome (ACS). The pathophysiology of ACS involves rupture of an atherosclerotic plaque; hence, treatment is aimed at plaque stabilization in order to prevent cellular death. However, there is considerable debate among clinicians, about which treatment pathway is best: early invasive using percutaneous coronary intervention (PCI/stent) when indicated or a conservative approach (i.e., medication only with PCI/stent if recurrent symptoms occur).
There are three types of ACS: ST elevation myocardial infarction (STEMI), non-ST elevation MI (NSTEMI), and unstable angina (UA). Among the three types, NSTEMI/UA is nearly four times as common as STEMI. Treatment decisions for NSTEMI/UA are based largely on symptoms and resting or exercise electrocardiograms (ECG). However, because of the dynamic and unpredictable nature of the atherosclerotic plaque, these methods often under detect myocardial ischemia because symptoms are unreliable, and/or continuous ECG monitoring was not utilized.
Continuous 12-lead ECG monitoring, which is both inexpensive and non-invasive, can identify transient episodes of myocardial ischemia, a precursor to MI, even when asymptomatic. However, continuous 12-lead ECG monitoring is not usual hospital practice; rather, only two leads are typically monitored. Information obtained with 12-lead ECG monitoring might provide useful information for deciding the best ACS treatment.
Purpose. Therefore, using 12-lead ECG monitoring, the COMPARE Study (electroCardiographic evaluatiOn of ischeMia comParing invAsive to phaRmacological trEatment) was designed to assess the frequency and clinical consequences of transient myocardial ischemia, in patients with NSTEMI/UA treated with either early invasive PCI/stent or those managed conservatively (medications or PCI/stent following recurrent symptoms). The purpose of this manuscript is to describe the methodology used in the COMPARE Study.
Method. Permission to proceed with this study was obtained from the Institutional Review Board of the hospital and the university. Research nurses identify hospitalized patients from the emergency department and telemetry unit with suspected ACS. Once consented, a 12-lead ECG Holter monitor is applied, and remains in place during the patient's entire hospital stay. Patients are also maintained on the routine bedside ECG monitoring system per hospital protocol. Off-line ECG analysis is done using sophisticated software and careful human oversight.

Continuous 12-lead electrocardiographic (ECG) monitoring can identify transient myocardial ischemia, even when asymptomatic, among patients with suspected acute coronary syndrome (ACS). In this article we describe our method for initiating patient monitoring using a Holter device, downloading the ECG data for off-line analysis, and how to utilize the ECG software to identify transient ischemia.

Each year, an estimated 785,000 Americans will have a new coronary attack, or acute coronary syndrome (ACS). The pathophysiology of ACS involves rupture ...

Myocardial Infarction and Functional Outcome Assessment in Pigs

Introduction of newly discovered cardiovascular therapeutics into first-in-man trials depends on a strictly regulated ethical and legal roadmap. One important prerequisite is a good understanding of all safety and efficacy aspects obtained in a large animal model that validly reflect the human scenario of myocardial infarction (MI). Pigs are widely used in this regard since their cardiac size, hemodynamics, and coronary anatomy are close to that of humans. Here, we present an effective protocol for using the porcine MI model using a closed-chest coronary balloon occlusion of the left anterior descending artery (LAD), followed by reperfusion. This approach is based on 90 min of myocardial ischemia, inducing large left ventricle infarction of the anterior, septal and inferoseptal walls. Furthermore, we present protocols for various measures of outcome that provide a wide range of information on the heart, such as cardiac systolic and diastolic function, hemodynamics, coronary flow velocity, microvascular resistance, and infarct size. This protocol can be easily tailored to meet study specific requirements for the validation of novel cardioregenerative biologics at different stages (i.e. directly after the acute ischemic insult, in the subacute setting or even in the chronic MI once scar formation has been completed). This model therefore provides a useful translational tool to study MI, subsequent adverse remodeling, and the potential of novel cardioregenerative agents.

This protocol describes the porcine myocardial infarction (MI) model using a 90 min closed-chest coronary balloon occlusion of the left anterior descending artery (LAD), followed by reperfusion. Furthermore, the protocol for several outcome parameters, such as cardiac function, hemodynamics, microvascular resistance, and infarct size, are also presented.

Introduction of newly discovered cardiovascular therapeutics into first-in-man trials depends on a strictly regulated ethical and legal roadmap. One ...

Using an Ingestible Telemetric Temperature Pill to Assess Gastrointestinal Temperature During Exercise

Exercise results in an increase in core body temperature (Tc), which may reduce exercise performance and eventually can lead to the development of heat-related disorders. Therefore, accurate measurement of Tc during exercise is of great importance, especially in athletes who have to perform in challenging ambient conditions. In the current literature a number of methods have been described to measure the Tc (esophageal, external tympanic membrane, mouth or rectum). However, these methods are suboptimal to measure Tc during exercise since they are invasive, have a slow response or are influenced by environmental conditions. Studies described the use of an ingestible telemetric temperature pill as a reliable and valid method to assess gastrointestinal temperature (Tgi), which is a representative measurement of Tc. Therefore, the goal of this study was to provide a detailed description of the measurement of Tgi using an ingestible telemetric temperature pill. This study addresses important methodological factors that must be taken into account for an accurate measurement. It is recommended to read the instructions carefully in order to ensure that the ingestible telemetric temperature pill is a reliable method to assess Tgi at rest and during exercise.

This study describes an accurate, reliable and non-invasive technique to continuously measure gastrointestinal temperature during exercise. The ingestible telemetric temperature pill is suitable to measure gastrointestinal temperature in laboratory settings as well as in field based settings.

Exercise results in an increase in core body temperature (Tc), which may reduce exercise performance and eventually can lead to the development of ...

A Quantitative Sensory Testing Paradigm to Obtain Measures of Pain Processing in Patients Undergoing Breast Cancer Surgery

Chronic pain following surgery, persistent postsurgical pain, is an important highly prevalent condition contributing to significant symptom burden and lower quality of life. Persistent postsurgical pain is relatively refractory to treatment hence generating a high need for preventive strategies and treatments. Therefore, the identification of patients at risk of developing persistent pain is an area of active ongoing research. Recently it was demonstrated that peri-operative disruptions in central pain processing may be able to predict persistent postsurgical pain at long term follow-up in breast cancer patients. The aim of the current report is to present a short protocol to obtain pain thresholds to different stimuli at multiple sites and a measure of endogenous analgesia in breast cancer patients. We have used this method successfully in a clinical context and detail some representative results from a clinical study.

Persistent postsurgical pain may be related to changes in pain processing. By assessing pain in response to standardized stimuli, changes in pain processing can be elucidated. We present methods to obtain pain thresholds to different stimuli and a measure of endogenous analgesia in patients undergoing breast cancer surgery.

Chronic pain following surgery, persistent postsurgical pain, is an important highly prevalent condition contributing to significant symptom burden and ...

Collecting Hair Samples for Hair Cortisol Analysis in African Americans

The hormone cortisol is typically assessed in saliva, serum, or urine samples. More recently, cortisol has been successfully extracted from hair, including humans. The advantage of hair cortisol concentration is that it reflects a retrospective representation of hypothalamic-pituitary-adrenal (HPA) axis function over time, much like hemoglobin A1C represents glycemic control. However, obtaining hair samples can be challenging, due to the cultural beliefs and hair care practices of minority participants. For example, African Americans may be reluctant to provide samples. Additionally, few researchers are trained to collect hair samples from African Americans. The purpose of this paper is to present a culturally informed protocol to help researchers obtain hair samples from African Americans. To illustrate the representative results of this protocol implementation, de-identified data from African Americans that participated in a community-based study on chronic stress are provided. Hair practice preferences are assessed. The participants are made comfortable by showing pictures of hair samples prior to cutting their hair. The single strain twist and gently pull method is used to collect approximately 30 - 50 strands of hair from the posterior vertex region of the scalp. This protocol will significantly improve collection of hair samples from African Americans.

Hair cortisol concentration analysis provides an alternative to traditional measures of cortisol; however, to collect hair samples from African Americans, scientists need to be culturally informed and competent. The purpose of this protocol is to demonstrate a culturally informed technique to collect hair samples for cortisol analysis from African Americans.

The hormone cortisol is typically assessed in saliva, serum, or urine samples. More recently, cortisol has been successfully extracted from hair, ...

Predicting Treatment Response to Image-Guided Therapies Using Machine Learning: An Example for Trans-Arterial Treatment of Hepatocellular Carcinoma

Intra-arterial therapies are the standard of care for patients with hepatocellular carcinoma who cannot undergo surgical resection. The objective of this study was to develop a method to predict response to intra-arterial treatment prior to intervention.
The method provides a general framework for predicting outcomes prior to intra-arterial therapy. It involves pooling clinical, demographic and imaging data across a cohort of patients and using these data to train a machine learning model. The trained model is applied to new patients in order to predict their likelihood of response to intra-arterial therapy.
The method entails the acquisition and parsing of clinical, demographic and imaging data from N patients who have already undergone trans-arterial therapies. These data are parsed into discrete features (age, sex, cirrhosis, degree of tumor enhancement, etc.) and binarized into true/false values (e.g., age over 60, male gender, tumor enhancement beyond a set threshold, etc.). Low-variance features and features with low univariate associations with the outcome are removed. Each treated patient is labeled according to whether they responded or did not respond to treatment. Each training patient is thus represented by a set of binary features and an outcome label. Machine learning models are trained using N - 1 patients with testing on the left-out patient. This process is repeated for each of the N patients. The N models are averaged to arrive at a final model.
The technique is extensible and enables inclusion of additional features in the future. It is also a generalizable process that may be applied to clinical research questions outside of interventional radiology. The main limitation is the need to derive features manually from each patient. A popular modern form of machine learning called deep learning does not suffer from this limitation, but requires larger datasets.

Intra-arterial therapies are the standard of care for patients with hepatocellular carcinoma who cannot undergo surgical resection. A method for predicting response to these therapies is proposed. The technique uses pre-procedural clinical, demographic, and imaging information to train machine learning models capable of predicting response prior to treatment.

Intra-arterial therapies are the standard of care for patients with hepatocellular carcinoma who cannot undergo surgical resection. The objective of this ...

Precision Implementation of Minimal Erythema Dose (MED) Testing to Assess Individual Variation in Human Inflammatory Response

Minimal erythema dose (MED) testing is frequently used in clinical settings for determining the smallest amount of ultraviolet (UV) irradiation necessary to produce erythema (inflammatory reddening) on the surface of the skin. In this context, the MED is regarded as a key factor in determining starting doses for UV phototherapy for common skin conditions such as psoriasis and eczema. In research settings, MED testing also has potential to be a powerful tool for assessing within- and between-persons variation in inflammatory responses. However, MED testing has not been widely adopted for use in research settings, likely owing to a lack of published guidelines, which is a barrier to obtaining reproducible results from this assay. Also, protocols and equipment for establishing MED vary widely, making it difficult to compare results across laboratories. Here, we describe a precise and reproducible method to induce and measure superficial erythema using newly designed protocols and methods that can easily be adapted to other equipment and laboratory environments. The method described here includes detail on procedures that will allow extrapolation of a standardized dosage schedule to other equipment so that this protocol can be adapted to any UV radiation source.

Precision Implementation of Minimal Erythema Dose MED Testing to Assess Individual Variation in Human Inflammatory Response

Minimal erythema dose (MED) testing is used to establish dosage schedules for ultraviolet radiation phototherapy. It can assess individual variation in inflammatory response but lacks methodology for achieving reproducible results. Here, we present a precision implementation of MED and demonstrate its ability to capture individual variation in inflammatory response.

Minimal erythema dose (MED) testing is frequently used in clinical settings for determining the smallest amount of ultraviolet (UV) irradiation necessary ...

Using Nicotine in a Silica-Exposed Mouse Model to Promote Lung Epithelial-Mesenchymal Transition

Smoking and exposure to silica are common among occupational workers, and silica is more likely to injure the lungs of smokers than non-smokers. The role of nicotine, the primary addictive ingredient in cigarettes, in silicosis development is unclear. The mouse model employed in this study was simple and easily controlled, and it effectively simulated the effects of chronic nicotine ingestion and repeated exposure to silica on lung fibrosis through epithelial-mesenchymal transition in human beings. In addition, this model can help in the direct study of the effects of nicotine on silicosis while avoiding the effects of other components in cigarette smoke.
After environmental adaptation, mice were injected subcutaneously with 0.25 mg/kg nicotine solution into the loose skin over the neck every morning and evening at 12 h intervals over 40 days. Additionally, crystalline silica powder (1-5 &#181;m) was suspended in normal saline, diluted to a suspension of 20 mg/mL, and dispersed evenly using an ultrasonic water bath. The isoflurane-anesthetized mice inhaled 50 &#181;L of this silica dust suspension through the nose and were awoken via chest massage. Silica exposure was administrated daily on days 5-19.
The double-exposed mouse model was exposed to nicotine and then silica, which matches the exposure history of workers who are exposed to both harmful factors. In addition, nicotine promoted pulmonary fibrosis through epithelial-mesenchymal transformation (EMT) in mice. This animal model can be used to study the effects of multiple factors on the development of silicosis.

This study describes a mouse model to study the synergistic effect of nicotine on the progression of pulmonary fibrosis in experimental silicosis mice. The dual-exposure mouse model simulates the pathological progression in the lung after simultaneous exposure to nicotine and silica. The methods described are simple and highly reproducible.

Smoking and exposure to silica are common among occupational workers, and silica is more likely to injure the lungs of smokers than non-smokers. The role ...

Flexible Bronchoscopy for Novice Bronchoscopists

Systematic Bronchoscopy: the Four Landmarks Approach

Flexible bronchoscopy is a technically difficult procedure and has been identified as the most important procedure that should be integrated into a simulation-based training program for pulmonologists. However, more specific guidelines that govern bronchoscopy training are needed to meet this demand. To ensure patients a competent examination, we propose a systematic, stepwise approach, splitting the procedure into four &#34;landmarks&#34; to support novice endoscopists navigating the bronchial maze. The procedure can be evaluated based on three established outcome measures to ensure a thorough and effective inspection of the bronchial tree: diagnostic completeness, structured progress, and procedure time.
The stepwise approach relying on the four landmarks is used at all simulation centers in Denmark and is being implemented in the Netherlands. To provide instant feedback to novice bronchoscopists when training and to relieve time constraints from consultants, we suggest that future studies should implement artificial intelligence&#160;as a feedback and certification tool when training new bronchoscopists.

Author Spotlight: Learning Systematic Bronchoscopy in a Simulation-Base Setting 

Here, we present a protocol to navigate the bronchial maze in a structured manner, splitting the bronchoscopy into a stepwise approach-the four landmarks approach.

Flexible bronchoscopy is a technically difficult procedure and has been identified as the most important procedure that should be integrated into a ...

Subclavian Vein Puncture Method for Repeated Blood Collection in Conscious Rats

Subclavian Vein Blood Sampling in Conscious Rats

There are several established methods for obtaining repeated blood samples from rats, with the most commonly employed methods being lateral tail vein sampling without anesthesia and jugular vein sampling with anesthesia. However, most of these methods require assistance and anesthetic equipment and sometimes pose difficulties in terms of blood collection or the poor quality of blood samples. In addition, these methods of blood collection consume significant time and human resources when repeated blood sampling is required for a large number of rats. This study presents a technique for repetitive blood sampling in non-anesthetized rats by a single proficient individual. Highly satisfactory blood samples can be obtained by puncturing the subclavian vein. The method demonstrated an impressive overall success rate of 95%, with a median time of merely 2 min from rat restraint to the completion of blood collection. Furthermore, performing consecutive blood collections within the designated range does not inflict any harm on the rats. This method is worth promoting for blood collection, especially in large-scale pharmacokinetic studies.

Author Spotlight: Developing an Efficient Blood Collection Method in Non-Anesthetized Rats 

Here we present a combination of effective rat restriction and subclavian vein puncture methods that enable rapid, safe, and repeated blood collection in rats without anesthesia.

There are several established methods for obtaining repeated blood samples from rats, with the most commonly employed methods being lateral tail vein ...