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Els periecs () foren la segona classe social de la polis d'Esparta, per sota els esparciates i per damunt els hilotes. Habitaven en poblacions de Lacedemònia o altres territoris dependents, però en qualsevol cas fora d'Esparta. Tenien drets polítics locals, en les seves respectives poblacions, però no dins l'estat espartà, que només contemplava els drets pels esparciates. No obstant això, eren personalment lliures, a diferència dels hilotes. Literalment, periec vol dir 'veí', el sentit més comú del terme, que en el cas espartà s'especialitzà per referir-se a aquesta classe social.

Aquesta condició es va originar a partir d'una conquesta; així, es deia que els habitants de Lacònia que eren aqueus van esdevenir periecs dels conqueridors doris. En realitat, tant els espartans com els seus veïns eren doris, o descendents de la mescla produïda entre els conqueridors doris i els aqueus autòctons. Posteriorment, els espartans sotmeteren els seus veïns i així esdevengueren periecs.

Inicialment es van establir unes determinades condicions de subjecció per les quals eren deixats en possessió dels seus drets privats de ciutadania, però van perdre part de les seves terres, van haver de reconèixer el rei o cap d'estat invasor; eren elegibles per tots els càrrecs excepte pel més alt. Però al cap d'una o dues generacions aquest arranjament es va trencar i els periecs van esdevenir vassalls dels conqueridors, potser després d'una revolta frustrada; les seves terres tenien taxes elevades i van perdre els drets de ciutadania (casar-se amb doris, vot a l'assemblea general, dret a ser elegits per les magistratures). No eren especialment oprimits però se situaven en un estat notablement inferior a la classe dominant encara que per damunt dels ilotes. Eren considerats tan allunyats dels espartans que els èfors podien ordenar la seva mort sense judici. Els més distingits van poder exercir alguns càrrecs especialment a la marina per la qual els espartans no estaven prou dotats; els periecs servien com a soldats de línia amb armes pesants, no com els ilotes que només portaven armes lleugeres. I per exemple a la Batalla de Platea lluitaven com a hoplites, amb un auxiliat ilota cadascun. Dels 292 presoners fets pels atenencs a Esfactèria, 120 eren espartans i la resta periecs. Tucídides diu que els periecs exercien alts comandaments, i al final de la guerra del Peloponès, un periec tenia el grau de navarc o almirall, però no exercien comandament sobre soldats espartans i el navarc dirigia una flota aliada de l'illa de Quios.

A la revolta dels ilotes de l'any 464 aC una part dels periecs s'hi van unir. El 368 aC quan els tebans van envair Lacònia, els periecs estaven disposats a ajudar-los. També es van mostrar els més hostils als espartans durant la revolta de Cinadó. Per tots aquests fets coneguts es pot considerar als periecs de Lacònia com a desafectes a l'estat. Per això els espartans els mantingueren dispersos en gran nombre de llogarets sense poder residir a les grans ciutats, i ocupant la part més improductiva del país, perquè la millor terra era pels espartans. Plutarc atribueix el repartiment de terres a Licurg, que va pensar en deixar sense gaires béns als periecs i els va assignar les terres accidentades i pedregoses.

Els periecs, encara que no assistien a les assemblees i no tenien altres drets, gaudien d'alguns avantatges, que no privilegis, que els espartans no tenien. El monopoli de la fabricació d'objectes i del comerç estava a les seves mans, ja que ocupaven les ciutats de la costa; també cultivaven les arts i la major part dels artistes de tota mena a Esparta eren periecs.

El nombre de ciutats dels periecs era d'unes cent, algunes a la costa com Gítion, el port d'Esparta, altres a l'interior com Túria o Cardamile; l'illa de Citera, el centre del comerç amb Egipte, també era poblada de periecs que rebien cada any un magistrat especial enviat per Esparta (el Justícia de Citera). Sembla que els periecs tenien els seus propis governants a les ciutats però hi havia una mena de governador espartà a diferents districtes que controlava sobretot temes administratius. S'han fet càlculs basats en el nombre de soldats aportats a Platea, i es pensa que la població de periecs era en aquells temps d'uns 66.000 habitants.

Les ciutats dels periecs van ser en part sostretes a Esparta per Tit Quinti Flaminí i incorporades a la Lliga Aquea. August va crear 24 noves comunitats lliures conegudes com a Eleutero-Lacònia (laconis lliures); encara algunes ciutats dels periecs van restar subjectes a Esparta.

Sembla que hi havia periecs a altres llocs com Beòcia (per exemple a Tèspies), l'Argòlida (per exemple a Ornea, virtualment independent fins al 580 aC) i a l'Èlida (Trifília). També hi havia periecs a les ciutats dòriques de Creta i a les colònies de Cirene i Tera.

Referències

Classes socials de l'antiga Grècia


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Die Zahlungskarte (auch Zahlkarte; ) ist ein Zahlungsmittel, die ihren Inhaber berechtigt, bei den am Zahlungsverfahren angeschlossenen Vertragsunternehmen (Händler, Verkäufer) Rechnungen gegen Vorlage der Karte durch bargeldlose Zahlung zu begleichen.

Das Bargeld als einziges gesetzliches Zahlungsmittel wird immer stärker durch den bargeldlosen Zahlungsverkehr verdrängt. Zu letzterem gehören nicht nur Überweisungen, Echtzeitüberweisungen oder Lastschriften, sondern auch der Zahlungsvorgang durch Kartenzahlungen oder ähnliche Systeme. Von den Zahlungskarten grenzen sich die reinen Bankkarten dadurch ab, dass letztere ausschließlich für Barauszahlungen, Bareinzahlungen und Kontoauszugsdrucker verwendet werden können.

Unter einer Zahlungskarte wird heute eine handelsübliche Plastikkarte im Scheckkartenformat verstanden. Der Aussteller der Karte sorgt durch Codierung mittels Magnetstreifen oder Chip dafür, dass Missbrauch oder Fälschung weitgehend ausgeschlossen werden und den Inhaber in die Lage versetzt, Geld oder einen monetären Wert zu übertragen. Der Karteninhaber muss eine Geldschuld erfüllen, so dass er die Karte selbst oder die auf dem Magnetstreifen oder Kartenchip gespeicherten Geldeinheiten – deren Träger letztlich die Karte ist – zu diesem Zweck verwenden kann.

Die Deutsche Bundesbank definiert die Zahlungskarte als einen Gegenstand, "mit dem der Inhaber über ein Kartensystem entweder Zahlungstransaktionen vornehmen oder Bargeld abheben bzw. einzahlen kann, sei es mit Hilfe einer Plastikkarte oder eines mobilen Geräts. Ein Kartensystem ist ein Rahmenwerk technischer und kommerzieller Regelungen, das für die Betreuung einer oder mehrerer spezifischer Kartenmarken eingerichtet wurde. Dieses Rahmenwerk enthält die organisatorischen und rechtlichen Bestimmungen wie auch die Rahmenbedingungen, die erforderlich sind, damit die von der Marke vermarkteten Dienste funktionieren."

Material
Zahlungskarten bestehen aus mehrschichtigem, beidseitig hochglänzend laminiertem PVC oder in seltenen Fällen aus Metall. Der Vorteil dieses mehrschichtigen Aufbaus besteht in der hohen Verformbarkeit und nahezu Unzerbrechlichkeit. Das Format von 85,6 mm × 53,98 mm × 0,76 mm abgerundeten Ecken mit einem Radius von 3,18 mm ist durch ISO 7810 vorgegeben.

Für Zahlungskarten im ID1-Format gelten derzeit folgende Formate: ISO 7810 für die äußere Gestaltung (), ISO 7816-2 für die Platzierung von Magnetstreifen und Chip () und ISO 7816-3 für die elektronischen Signale und die verwendeten Protokolle ().

Bestandteile
Zahlungskarten zeigen auf der Vorderseite das Logo des Ausstellers, den Namen des Karteninhabers und des kontoführenden Kreditinstituts, den integrierten Chip, auf der Rückseite befinden sich die Unterschriftsprobe des Karteninhabers und der Magnetstreifen. Der Chip wird bei Kartennutzung durch den Chipkartenleser ausgelesen, der Magnetstreifen durch einen Durchzugleser. Die Chipkarte entspricht der Norm ISO 7816-1, Chip und Magnetstreifen sind beide noch für einen Übergangszeitraum erforderlich (ISO 7816-2).

Arten
Eine Kartenzahlung ist eine Zahlung, bei der kontogebundene (beispielsweise Debitkarten) und nicht kontogebundene Zahlungskarten (wie Kreditkarten) eingesetzt werden.
 Bei Debitkarten () werden die bargeldlosen Zahlungen (und die Barauszahlungen) kurzfristig dem Girokonto des Kartenzahlers belastet. Die Identität des Karteninhabers wird hier zumeist mit einer PIN überprüft. Die wichtigste Debitkarte ist die Maestro-Karte. Weitere Systeme sind V Pay und die deutsche girocard.
 Bei Kreditkarten () werden die bargeldlosen Zahlungen (und die Barauszahlungen) entweder einmal monatlich mit einer Liste aller Zahlungen in Rechnung gestellt () oder bis auf einen Betrag, der mindestens zu bezahlen ist, kreditiert (). Die Identität des Karteninhabers wird zumeist durch Unterschrift überprüft. Die wichtigsten Kreditkarten sind Mastercard-, Visa-, American-Express- und Diners-Club-Karten.
 Bei elektronischen Geldbörsenkarten () muss deren Chip zunächst mit einem Guthaben aufgeladen werden, um die später erfolgenden bargeldlosen Zahlungen durchführen zu können. Nach Verbrauch ist erneut ein Aufladen erforderlich. Bei der Zahlung wird wie bei Bargeld nicht die Identität überprüft, der Käufer bleibt gegenüber dem Verkäufer/Händler anonym. Elektronische Geldbörsen befinden sich meist als Zusatzfunktion auf anderen Karten. Die elektronische Geldbörse in Deutschland ist die Geldkarte und in der Schweiz Cash. Die österreichische Lösung Quick wurde mit dem 31. Juli 2017 eingestellt.
Außerdem gibt es mobiles Bezahlen durch Smartphones, Tablets oder Wearable Computing, das durch kontaktloses Bezahlen erfolgt. Technologien wie Bluetooth, QR-Codes oder das Kontaktlosverfahren durch Near Field Communication (NFC) können hier zur Übertragung der Zahlungsdaten verwendet werden. Die NFC-Funktion wird teilweise auch bei Zahlungskarten berücksichtigt.

Ferner können Zahlungskarten wie folgt unterteilt werden:
 Nach der Liquiditätswirkung für den Inhaber:
 Kreditkarte: Der Zeitraum zwischen Zahlung und Belastung beträgt mindestens einen Monat.
 Chargekarte: Auch bei ihr erhält der Karteninhaber monatlich eine Rechnung, die sofort bzw. innerhalb einer Frist von bis zu 30 Tagen zahlbar ist.
 Debitkarte: Der Karteninhaber wird nach Bezahlung sofort belastet.
 Guthabenkarte: Der Karteninhaber muss Vorauszahlungen leisten, bevor er mit ihr zahlen kann.
 Nach dem Einsatzbereich:
 internationale Zahlungskarten: beispielsweise American Express, Diners Club, Mastercard oder Visa;
 nationale Zahlungskarten:
 von Kreditinstituten: etwa Bankcard-Servicenetz oder Girocard;
 Kundenkarten von Handels- und Dienstleistungsunternehmen wie etwa Payback oder Kundenkarten von Bahngesellschaften (beispielsweise Bahncard).
 Nach dem Speichermedium:
 Magnetstreifenkarte: Sie enthält einen meist auf der Rückseite angebrachten Magnetstreifen, dessen gespeicherte Daten mittels eines Durchzuglesers ausgelesen werden können.
 Chipkarte: Der Chip ist ein integrierter Schaltkreis und dient bei E-Geldverfahren als spezifisches Speichermedium, mit dem die Informationen über das Kartenguthaben verwaltet werden.
 Hybridkarte: Enthält sowohl einen Magnetstreifen als auch einen Chip.
Keine Zahlungskarten sind Kundenkarten oder Telefonkarten, die lediglich bargeldlose Einkäufe oder Telefonate ermöglichen.

Zahlungsablauf
Die Zahlungskarte wird vom Verkäufer/Händler (Vertragsunternehmen) entgegengenommen, der die Identitätsfeststellung vornimmt, den Rechnungsbetrag mit den Kartendaten zum Leistungsbeleg verbindet sowie erforderlichenfalls die PIN und die Unterschrift vom Kartennutzer anfordert. Die Zahlungspflicht des Kartenausstellers wird vom Vertragsunternehmen durch den Zusatz "Unterschrift des Karteninhabers ist auf dem Leistungsbeleg vorhanden" () ausgelöst. Diese Zahlungspflicht des Kartenunternehmens entsteht nur, wenn das Vertragsunternehmen mit Hilfe des POS-Terminals ordnungsgemäße Leistungsbelege erstellt. Diese Regelung schreibt eine sachgemäße Dokumentation der abgewickelten Geschäfte vor, die insbesondere zur Bearbeitung etwaiger Beschwerden eines Karteninhabers benötigt wird. Die Angabe "signature on file" ist stets eine notwendige Voraussetzung der Zahlungspflicht des Kreditkartenunternehmens im Präsenzverfahren, die Zahlungspflicht im Mailorderverfahren entsteht auch ohne den Vermerk "signature on file" auf den Leistungsbelegen, wenn Bestellungen per E-Mail/Internet übermittelt werden und dem Vertragsunternehmer die Unterschriften der Karteninhaber nicht vorliegen.

Rechtsfragen
Die Zahlungskarte ist nach Art. 2 Nr. 15  ein Zahlungsinstrument, das dem Zahler ermöglicht, Debit- oder Kreditkartentransaktionen zu veranlassen. Bei "garantierten" Zahlungskarten übernimmt deren Aussteller (Issuer oder Acquirer) eine Zahlungsgarantie, der ein abstraktes Schuldversprechen gemäß  BGB zugrunde liegt.

Das Strafrecht kennt Zahlungskarten als Rechtsbegriff, der sie als Tatobjekt behandelt. Pendant für den Straftatbestand der Geldfälschung bei Bargeld ist der Kreditkartenbetrug. Dabei regelt  StGB die Fälschung von Zahlungskarten ohne Garantiefunktion und  StGB die Fälschung von Zahlungskarten mit Garantiefunktion. Zahlungskarten ohne Garantiefunktion sind die von einem Kreditinstitut oder Finanzdienstleistungsinstitut herausgegebenen kontogebundenen Karten (Debitkarten), zu den Zahlungskarten mit Garantiefunktion gehören die nicht kontogebundenen Kreditkarten. § 152a StGB erfasst nicht Kundenkarten und Telefonkarten.

Elektronische Geldbörsen können durch Hacker attackiert werden. Als Ausspähen von Daten () wird das unerlaubte Eindringen in ein fremdes Computersystem oder Computernetzwerk unter Überwindung der Zugangssicherung verstanden, um sich oder einem anderen unbefugt Zugang zu Daten zu verschaffen, die nicht für ihn bestimmt und die gegen unberechtigten Zugang besonders gesichert sind ( StGB). Zudem kann der Computerbetrug nach  StGB erfüllt sein, bei dem jemand das Ergebnis eines Datenverarbeitungsvorgangs durch unrichtige Gestaltung des Programms, durch Verwendung unrichtiger oder unvollständiger Daten, durch unbefugte Verwendung von Daten oder sonst durch unbefugte Einwirkung auf den Ablauf beeinflusst.

Wirtschaftliche Aspekte
Zahlungskarten sind das am weitesten verbreitete und am häufigsten verwendete bargeldlose Zahlungsmittel in Europa und der Eurozone. Die Anzahl der im Euro-Währungsgebiet umlaufenden Karten mit Zahlungsfunktion erhöhte sich im Jahr 2018 um 4,0 % auf 544,0 Millionen. Bei einer Gesamtbevölkerung im Euroraum von 341 Millionen entspricht das rund 1,6 Zahlungskarten je Einwohner. Die Zahl der Kartenzahlungen stieg um 13,0 % auf 41,4 Milliarden mit einem Gesamtwert von 1,8 Billionen Euro. Dies entspricht einem durchschnittlichen Wert von rund 44 Euro je Kartenzahlung. Bereits 46 % aller bargeldlosen Transaktionen im Euroraum waren Kartenzahlungen, 23 % entfielen jeweils auf Überweisungen (inklusive Echtzeitüberweisungen) und Lastschriften. Der höchste Anteil der Kartenzahlungen mit 70,5 % lag in Portugal und jener der Überweisungen mit 43,6 % in der Slowakei, während bei den Lastschriften der höchste nationale Anteil mit 46,9 % – wie auch schon in den Vorjahren – auf Deutschland entfiel.

Allein in Deutschland befanden sich 2018 insgesamt 158,8 Millionen Zahlungskarten an Kunden in Umlauf, weit mehr als in jedem anderen europäischen Land. Allerdings lag hier der Anteil der Kartenzahlungen mit 23,4 % noch unterhalb des Anteils der Überweisungen (28,5 %). Gleichzeitig sank der Anteil der Barzahlungen am Umsatz stetig von 53,1 % (2011) auf 47,6 % (2017), während die Debitkarten von 28,3 % auf 34,0 % stiegen. Bei den Transaktionen führte die Barzahlung mit einem Anteil von 74,3 %, Debitkarten nahmen zu auf 18,4 %, Kreditkarten verharrten bei 1,5 %.

Seit dem Jahre 2011 stieg die Anzahl der Kartenzahlungen in Deutschland je Einwohner von 36,6 (2011) über 45 (2013) auf 54,4 (2017) an, also hatte jeder Einwohner im Jahr 2017 im Durchschnitt 54,4 Kartenzahlungen getätigt. Bei Beträgen bis 5 Euro liegt in Deutschland der Barzahlungsanteil bei 96 %, zwischen 5 und 20 Euro bei 88 %, 20 bis 50 Euro noch bei 60 %. Erst bei Beträgen ab 50 bis 100 Euro überwiegt die Debitkarte (45 %), ab 100 Euro liegt der Barzahlungsanteil bei 24 %.

Laut einer Studie des EHI Retail Institutes wurden im Jahr 2019 insgesamt 224,6 Milliarden Euro mit Kartenzahlungen umgesetzt.  Das globale Marktforschungsunternehmen Euromonitor International belegte, dass im Jahr 2020 in Folge der Coronapandemie und der Beachtung von Hygienefaktoren das Kartenzahlungsvolumen erstmals in der Geschichte sämtliche Bargeldtransaktionen überstieg.

Siehe auch
 Zahlungskarte
 Bargeldbezugskarte (ohne Zahlungsfunktion)

Weblinks

Einzelnachweise

Bankwesen
Zahlungsverkehr
Unbarer Zahlungsverkehr
Chipkarte
Zahlungsmittel

redpajama_set_name: RedPajamaWikipedia


"The industrialist's son was kidnapped"
He had attempted to abduct the two children.
I can say you abduct a high school student.
He had attempted to abduct the three boys.
They abducted a child from his home yesterday.
The police caught the man who tried to abduct the boy for ransom.
Rumors swept the city that she had been abducted.
He was afraid of being abducted by a rival gang.
She was abducted at the gunpoint by the robbers.
His forefather was abducted to America two centuries ago.


text:
Home > Jobs in South Dakota
Listed below are current jobs in South Dakota.
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Pierre, South Dakota
Overview SUMMARY The Senior .Net Developer will be working with a team of developers and business analysts to develop new products /enhance existing systems in place. To be successful in this role, one must demonstrate their knowledge of critical...
The Board of Directors at Southeastern Electric Cooperative (Southeastern) is looking for an experienced electric utility leader to join the cooperative as its next CEO. The preferred start date is July 2023. Southeastern's new leader will replace Brad...
MLT - Medical Laboratory Technician or MLS - Medical Laboratory Scientist - Sanford Health 4th & Syc
Create Your Career With Us! Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford...
Aberdeen, South Dakota
Description The Senior IT Project Manager oversees the delivery of various technical projects of a highly complex nature in Enterprise Information Protection (EIP). We are seeking a candidate who will be a part of EIP's Identity & Access Management...
Staff Software Engineer
It's fun to work in a company where people truly BELIEVE in what they're doing! We're committed to bringing passion and customer focus to the business. Proofpoint is looking for a Staff Software Engineer. Our engineering team is dynamic, fluid, and...
Data Engineer - Fully Remote
Description You will be part of our Clinical Data and Reporting team which builds applications that deliver aggregated operational and Analytics data used across the organization. This is a unique challenge which requires deep SQL and database design...
MLT - Medical Laboratory Technician or MLS - Medical Laboratory Scientist - Sanford Sports Complex -
MLS - Medical Laboratory Scientist or MLT - Medical Laboratory Technician - Sanford USD Medical Cent
MLT - Medical Laboratory Technician or MLS - Medical Laboratory Scientist - Sanford Health - 69th &
Infrastructure Engineer - Windows and IIS Servers (On Prem and AWS)
Nelnet is a diversified and innovative company committed to enriching lives through the power of service as a student loan servicer, professional services company, consumer loan originator and servicer, payments processor, and K-12 and higher education...

redpajama_set_name: RedPajamaCommonCrawl


Posted on March 31, 2018 by Maxxam Realty Ltd.
I have listed a new property at 6534 Throup RD in SOOKE.
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text:
2019 | January-April | Volume 23 | Issue 1
[Year:2019] [Month:January-April] [Volume:23] [Number:1] [Pages:1] [Pages No:0 - 0]
M Madhulatha, Vijayabhaskar M
Evaluation of Therapeutic Efficacy of Antioxidants in Psoriatic Cases
[Year:2019] [Month:January-April] [Volume:23] [Number:1] [Pages:3] [Pages No:167 - 169]
Keywords: Antioxidants, MDA, Oxidative stress, Psoriasis, Total antioxidant capacity
How to cite this article: Madhulatha M, M V. Evaluation of Therapeutic Efficacy of Antioxidants in Psoriatic Cases. Indian J Med Biochem 2019; 23 (1):167-169.
Introduction: Psoriasis is one of the debilitating diseases of the skin of chronic inflammatory origin. Oxidative stress is considered as the culprit for the oxidant and antioxidant imbalance, resulting in psoriasis. Objectives: This study was undertaken to know the effects of oxidative stress in the origin and development of psoriasis and to evaluate the beneficial effect of antioxidant therapy in psoriatic patients along with conventional treatment. Materials and methods: Thirty-three patients of age group 20–60 years with chronic plaque psoriasis, from the outpatient department of Dermatology, Mamata General Hospital, Khammam, Telangana, India were considered for the study. Patients with a duration of disease from 6 months to 2 years were enrolled for the study. The severity of psoriasis was determined using the psoriasis area severity index (PASI). Informed consent from the patients and institutional ethical committee clearance were taken. Antioxidant therapy was given for 8 weeks along with conventional therapy. Malondialdehyde (MDA) and total antioxidant capacity were measured and compared before and after the therapy. Results: After antioxidant therapy for 8 weeks, it was observed that there was a significant decrease in mean serum levels of MDA and increased levels of total antioxidant capacity (TAC). Conclusion: The results revealed that antioxidant therapy along with conventional therapy of psoriasis is more beneficial in the treatment of psoriatic cases.
M Madhulatha
Assessment of Serum Homocysteine and Oxidative Stress in Vitiligo Patients
Keywords: Homocysteine, MDA, Oxidative stress, Total antioxidant capacity, Vitiligo
How to cite this article: Madhulatha M. Assessment of Serum Homocysteine and Oxidative Stress in Vitiligo Patients. Indian J Med Biochem 2019; 23 (1):170-173.
Introduction: Vitiligo is a pigmentation disorder affecting about 1–2% of the population with a multifactorial etiology. This condition may be acquired or often an inheritable disorder with polygenic inheritance pattern and complex pathogenic behavior. Increased Serum homocysteine levels and oxidative stress resulting from oxidant–antioxidant imbalance may play a vital role in the pathogenesis of vitiligo. Objectives: The present study aims to evaluate the serum levels of homocysteine and serum malondialdehyde (MDA) and total antioxidant capacity (TAC) in vitiligo patients and also to study the role of the same in the pathogenesis of the disease. Materials and methods: The study group comprised of 32 vitiligo patients of 16–40 years age group, attending outpatient department (OPD) in the Dermatology department of Mamata General Hospital, Khammam, Telangana, India. Thirty-two healthy individuals of the corresponding age group were selected as controls (control group) from the patient's attendants and hospital staff. Approval was obtained from the Institutional Human Ethical Committee. Prior informed consent was obtained from the selected participants. Serum level of homocysteine was measured using Axis homocysteine enzyme immunoassay (EIA). The MDA was determined as thiobarbituric acid reactive substances (TBARS). The total antioxidant capacity was estimated using ferric reducing ability of plasma (FRAP) assay. Results: Mean serum levels of homocysteine and MDA were significantly increased, and TAC was decreased considerably in vitiligo cases compared to controls. Conclusion: In cases of vitiligo patients, along with routine screening for homocysteine and oxidative stress status, the usage of antioxidants and homocysteine lowering agents such as vitamin B6, B12, and folic acid may prove beneficial as therapeutic agents.
Kuzhandai Velu V, Ramesh Ramasamy, Mohammad Hanifah, Lenin M
Circulating MiR-1 Levels in Acute Myocardial Infarction and Its Significance in Differential Diagnosis and Prognosis
Keywords: Acute myocardial infarction, Hs cnTn T, miR-1
How to cite this article: V KV, Ramasamy R, Hanifah M, M L. Circulating MiR-1 Levels in Acute Myocardial Infarction and Its Significance in Differential Diagnosis and Prognosis. Indian J Med Biochem 2019; 23 (1):174-177.
Background: Acute myocardial infarction (AMI) is a condition where there is a formation of thrombus which reduces the blood flow in the coronary arteries resulting in coronary vasospasm, further leading to cardiac muscles dysfunction or even death. Quick and accurate diagnosis of AMI plays a major role in the management and prognosis of this disease. Circulating miRNA has been a promising cardiac biomarker for AMI as well as cardiovascular disease in recent years. In the circulation miR 1 overexpressed when there is any damage in the cardiac cell. A very few articles documented the use of miR-1 as a diagnostic marker in AMI. The aim of the study was to find the diagnostic and prognostic role of miR-1 in AMI. Methodology: In this study, 62 AMI patients in the age group of 30–75 years and 30 healthy controls were included. Blood samples were collected at a different time of admission, 6 hours, 12 hours, 24 hours and 72 hours for the subject. Serum was separated immediately for the analysis of CK (NAC) and CK MB, Hs troponin T and micro-RNA-1 was quantification by RT-PCR. To study the kinetics of miR-1 repeated measure of analysis of variance (ANOVA) was analyzed. To find the diagnostic utility AUC, likelihood and odd's ration was performed. Results: The miR-1 expression is expressed in a change in fold 27.36, 57.17, 43.55, 32.50 and 24.09 fold increase at the different time. The study revealed that the sensitivity 69%, specificity 66%, LR was 1.59 and OR 4.04 in the differential diagnosis of AMI. Conclusion: In a total expression of miR-1 showed statistical significance in different time internal which will help us to use in the differential diagnosis of AMI.
P Kughapriya, JA Elanchezhian
Stability of Common Biochemical Analytes in Serum when Subjected to Changes in Storage Conditions and Temperature
Keywords: Accuracy, Aliquot, Analytes, Preanalytical, Precision
How to cite this article: Kughapriya P, Elanchezhian J. Stability of Common Biochemical Analytes in Serum when Subjected to Changes in Storage Conditions and Temperature. Indian J Med Biochem 2019; 23 (1):178-181.
Aim: The aim of the study was to assess the effect of storage time and temperature on the test results of 8 common biochemical analytes in serum. Materials and methods: Five mL of blood was collected from apparently healthy 80 volunteers in a clot activator tube without anticoagulant. Serum was separated after allowing the sample to clot for 30 minutes at room temperature. Separated serum was made into four aliquots. The first part analyzed within two hours act as a baseline value, while the other three aliquots were stored at room temperature for four hours, at 2–8° C for four hours and at 2–8° C for 24 hours, respectively. Results: Baseline serum values of common biochemical analytes analyzed within two hours of sample collection on comparison with the same sample stored at room temperature for four hours showed a significant change in the values of glucose, urea, creatinine, total bilirubin, albumin, and total protein. Also the values of glucose, urea and albumin were significantly changed on comparing the baseline sample with the sample that is stored for four hours at 2–8° C. Finally we compared the baseline values with the sample stored at 2–8° C for 24 hours and found a significant change among the values of glucose, total bilirubin, and albumin. Other analytes were found to be stable. Conclusion: According to our study, storage of common biochemical analytes in serum like glucose, urea, bilirubin, and albumin is not advisable. Serum creatinine and total protein were stable on refrigeration. Total cholesterol and triglycerides were found to be stable. Clinical significance: In the context of patient centered approach to the delivery of healthcare services, clinical laboratories play a vital role. Despite the improvements made in the laboratory, errors still occur due to inadequate insight about the importance of sample collection and storage procedures. Errors in sample handling affects test report which diminishes the confidence in healthcare services and damages an institution's reputation. Significant interdepartmental cooperation is very essential for identification and proper management of preanalytical errors which inturn will help to make valuable medical decision and effective patient care.
Debapriya Rath, Damini S Tomar, Prafulla K Khodiar, Pradeep K Patra
Evaluation of Serum Electrolytes in Sickle Cell Disease Patients with Respect to Hydroxyurea Therapy
Keywords: Electrolytes, Hydroxyurea, Sickle cell anemia, Serum magnesium
How to cite this article: Rath D, Tomar DS, Khodiar PK, Patra PK. Evaluation of Serum Electrolytes in Sickle Cell Disease Patients with Respect to Hydroxyurea Therapy. Indian J Med Biochem 2019; 23 (1):182-184.
Background: Sickle cell disease is one of the oldest genetic disorders known to medical science. The morbidity and mortality associated with the disease and its complication, sickle cell crisis, amounts to be a significant health issue. Hydroxyurea, originally used as an anticancer agent, has proved to be the wonder drug in lower doeses in sickle cell diease. The severity and impact of the disease on the affected person is decreased by a great extent by its use. The mechanism of action of the drug in sickle cell disease is yet to be completely understood. Electrolytes play a crucial role in the pathophysiology of sickle cell disease. Aim: The current study aims to evaluate the serum electrolyte levels in sickle cell disease patients and look for the effect of hydroxyurea on them. Materials and methods: Fifty two sickle cell disease (SS) patients and 20 normal individuals were included in the study (AA). Thirty four of the SS patients were under hydroxyurea therapy. The serum levels of magnesium, sodium, potassium, chloride, calcium, phosphate were estimated in all the study subjects. Results and discussion: No significant difference was found with respect to the serum electrolytes in the sickle cell patients under and not under hydroxyurea therapy. But the serum electrolytes varied significantly between the sickle cell disease patients and the normal individuals. Conclusion: Serum electrolytes play a crucial role in the pathophysiology of sickle cell disease, but hydroxyuera therapy does not seem to play a great role in altering their levels in the patients.
Swathi Kamal, Shubha Jayaram, Sreenivas N, Dharmendra BL, Sudha B Sreenivas
Estimation of Serum Electrolytes in Cases of Irritable Bowel Syndrome and Healthy Adults: A Comparative Study
Keywords: Electrolyte analyzer, Ion-selective electrode, Irritable bowel syndrome, Rome III criteria, Serum electrolytes
How to cite this article: Kamal S, Jayaram S, N S, BL D, Sreenivas SB. Estimation of Serum Electrolytes in Cases of Irritable Bowel Syndrome and Healthy Adults: A Comparative Study. Indian J Med Biochem 2019; 23 (1):185-188.
Irritable bowel syndrome (IBS) is one of the most prevalent, multifactorial, heterogeneous and complex disorders that affects up to 1 in 5 people over their lifetime. It significantly reduces patients' quality of life. Individuals diagnosed with IBS have "low-grade intestinal inflammation", and increased intestinal permeability. This can create an electrolyte imbalance. This study was taken up as there is a paucity of literature and controversial reports on serum electrolytes in IBS. Objectives: The objectives of this study were to estimate serum electrolyte levels in patients with IBS and to compare the same with that of normal healthy adults. Materials and methods: This study was conducted on 108 individuals in the age group of 18–60 years of whom 54 were diagnosed IBS cases and 54 were normal controls. Estimation of serum electrolytes was done with the collected venous blood samples using the Ion selective electrode technique in an electrolyte analyzer. Results: Near normal mean serum sodium levels and a slight decrease in mean potassium level with a statistically significant increase in the mean serum chloride were the findings observed in our study group when compared with the controls. Conclusion: IBS remains an enigmatic cause of significant distress, morbidity and disability. Our study implies that serum electrolyte levels are not greatly altered in IBS cases probably due to the rapid transit in colon, mucoidal consistency and small volume of stools. Lack of specific biomarkers adds to its complexity. Hence a multipronged approach is essential to improve the health related quality of life in these patients. Clinical significance: Since this functional disorder is highly associated with significant emotional distress, impaired health-related quality of life, disability and high health care costs, this study tries to understand the possible changes that can be incorporated in the diet or serum electrolyte supplementation in IBS cases.
A Khadeja Bi, R Chitraa
Plasma B-type Natriuretic Peptide Levels in Stable Heart Failure Patients
Keywords: B-type natriuretic peptide, Biomarker, Case-control study, Heart failure
How to cite this article: Bi AK, Chitraa R. Plasma B-type Natriuretic Peptide Levels in Stable Heart Failure Patients. Indian J Med Biochem 2019; 23 (1):189-192.
Introduction: Heart failure (HF) is a major and growing public health problem among the global population. Cardiac biomarkers are a promising tool for the early and specific detection of heart failure. B-type natriuretic peptide (BNP) is one such cardiac biomarker released in response to ventricular myocyte stretch. Aim: The aim of the present study was to estimate the levels of plasma BNP in patients with stable chronic heart failure (CHF) and to compare them with controls. Further to correlate the relationship between plasma BNP levels and factors like age, gender and left ventricular ejection fraction (LVEF), in the two groups. Materials and methods: A case-control study conducted in Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India consisting of 55 stable CHF patients on treatment and 35 controls. Serum creatinine was estimated adopting modified Jaffe's method. eGFR was calculated using the modification of diet in renal disease (MDRD) formula. Plasma BNP levels were measured by ELISA. Results: The mean BNP concentration in patients with stable CHF was 60.46 ± 16.13 pg/mL, while in controls it was 20.94 ± 5.81pg/mL and the difference was highly significant (p= 0.001). As the age increases an increasing trend in the values of plasma BNP was observed in both groups. There was a strong negative linear relationship (r = -0.798) observed between LVEF and BNP levels in the study population. A cut-off level of 30.2pg/mL for plasma BNP had a 100% sensitivity and specificity to predict CHF. Conclusion: Our study concludes that plasma BNP was significantly higher in patients with stable chronic heart failure than in the controls. Plasma BNP as a biomarker will help in identifying stable CHF patients who are asymptomatic, on their adequacy of treatment.
Malathi M
Comparative Study of Transudate and Exudate Pleural Fluid Using C-reactive Protein, Uric Acid and Malondialdehyde as Markers
Keywords: C-reactive protein, Malondialdehyde, Uric acid
How to cite this article: M M. Comparative Study of Transudate and Exudate Pleural Fluid Using C-reactive Protein, Uric Acid and Malondialdehyde as Markers. Indian J Med Biochem 2019; 23 (1):193-196.
Introduction: Pleural effusion is one of the most important debilitating disorders caused by various pathological conditions. It is a common clinical disorder and is either a manifestation or a complication of one or other respiratory of non-respiratory diseases. Diagnosing the type of effusion as an exudate or transudate is equally important in identifying the cause and treating accordingly to the type of pleural effusion. Hence, the use of light's criteria to separate transudate from exudate has been generally the admitted first step in any study of pleural effusion of the unknown cause. As the pleural effusion may increase the local oxidative stress so that pleural fluid can be analyzed for the oxidative stress marker as one of the tool additives with the light's criteria for the better differentiating the exudative from transudative type of effusion. Aim: Estimate levels of malondialdehyde (MDA), C-reactive protein (CRP) and uric acid in pleural fluid and compare the levels in exudative and transudative pleural fluid. Materials and methods: The samples for the study were collected after taking informed consent. The pleural tapping was done under all required aseptic precaution. It was divided into two groups—transudative pleural effusion (group 1) and exudative pleural effusion (group 2) by using Light's criteria. Samples were analyzed for the MDA, CRP and uric acid. Results and conclusion: MDA and CRP values have shown significantly increased levels in the pleural fluid of exudative type compared to transudative, but pleural uric acid levels were lower in exudative. However, there was no much difference between these parameters in serum levels among groups. The present study showed that oxidative stress is more in the exudates compared to transudates, probably due to the higher production of reactive oxygen species; it may serve as markers for differentiating between exudates and transudates.
Ivvala A Shaker, Suritha PK, Neha D Sheth, Inampudi Sailaja
Evaluation of Thyroid Profile and Complement 'C3' in Metabolic Syndrome
Keywords: FPG, PPG, FT3, FT4, TSH, HbA1c, Serum complement C3
How to cite this article: Shaker IA, PK S, Sheth ND, Sailaja I. Evaluation of Thyroid Profile and Complement 'C3' in Metabolic Syndrome. Indian J Med Biochem 2019; 23 (1):197-202.
Diabetes mellitus (DM) is associated with thyroid dysfunction. The aim of this present study was to measure the level of thyroid hormones (FT3, FT4, TSH), FPG, PPG, HBA1C, serum C3 in type II diabetic patients of either sex and to assess their clinical presentations and to compare and correlate the findings with males and females. In this study, 177 type II diabetic subjects and 100 healthy control subjects were investigated for FT3, FT4, and TSH. FPG, PPG, HbA1C, and S C3 complement were measured as supplementary parameters to predict the immune system. The level of TSH was significantly higher in type II diabetics as compared to control, but FT3 and FT4 did not show statistical significance. Significantly higher levels of FPG, PPG, HbA1C, and serum C3 and were also noted but serum C3 showed a significant increase with some immune dysfunction compared to control subjects. Type II diabetes should undergo regular screening to detect asymptomatic thyroid dysfunction along with complement C3 and other biochemical parameters to improve the quality of life and reduce the complication rate.
Palani S Mohanraj, Angel M Sylus, Thyagaraju Chitra
Elevated Luteinizing Hormone, Testosterone and Free Triiodothyronine with Increase in Body Mass Index in Polycystic Ovary Syndrome
Keywords: Gonadotropins, Luteinizing hormone, Obesity, Polycystic ovary syndrome, Testosterone, Thyroxine
How to cite this article: Mohanraj PS, Sylus AM, Chitra T. Elevated Luteinizing Hormone, Testosterone and Free Triiodothyronine with Increase in Body Mass Index in Polycystic Ovary Syndrome. Indian J Med Biochem 2019; 23 (1):203-206.
Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women in the reproductive age group. The association of testosterone, luteinizing hormone (LH), follicle stimulating hormone (FSH) and thyroid hormones in obese PCOS women are not clear. Hence, the present study was performed to assess the serum levels of gonadotrophins, testosterone and thyroid hormones in obese and nonobese PCOS women. Materials and methods: Sixty-three patients (41 obese and 22 nonobese) with PCOS were recruited for the study. Serum levels of testosterone, LH, FSH, thyroid stimulating hormone (TSH), free thyroxine (free T4) and free triiodothyronine (free T3) levels were measured. Results: Serum LH (p = 0.040), testosterone (p = 0.010) and free triiodothyronine (p = 0.006) levels were significantly elevated in obese PCOS women as compared to non-obese PCOS women. Both LH (r = 0.478, p = 0.002) and free T3 (r = 0.379, p = 0.036) were correlating positively with body mass index (BMI) in obese PCOS subjects. Testosterone was positively associated with duration of infertility in obese PCOS women (R2 = 0.187, â = 0.433, p = 0.005) Conclusion: We conclude that LH, testosterone and free T3 levels are increased with increase in BMI among women with PCOS.
M Manju, Suryapriya Rajendran, Sasmita Mishra, Pavithra M
Serum Liver and Pancreatic Enzymes in Chronic Kidney Disease with and without End-stage Renal Disease: A Comparative Study
Keywords: Chronic kidney disease, GFR, Hepatic and pancreatic enzymes
How to cite this article: Manju M, Rajendran S, Mishra S, M P. Serum Liver and Pancreatic Enzymes in Chronic Kidney Disease with and without End-stage Renal Disease: A Comparative Study. Indian J Med Biochem 2019; 23 (1):207-212.
Introduction: Chronic kidney disease (CKD) is emerging as an important chronic disease globally. The occurrence of liver and pancreatic diseases as comorbid conditions is very common. Estimation of liver and pancreatic enzymes still remains the main modality of diagnosis and monitoring hepatic and pancreatic diseases. Alterations in the enzyme levels in the absence of liver and pancreatic diseases have been reported. Hence we decided to compare the serum levels of liver and pancreatic enzymes (AST, ALT, ALP, GGT amylase and lipase) among CKD patients without end-stage renal disease (ESRD), patients with ESRD and healthy controls and to correlate the enzyme levels with eGFR (severity). Materials and methods: The present study was conducted in a tertiary care hospital with 100 controls, 100 CKD patients without ESRD and 100 ESRD patients. All the 300 patients had no evidence of hepatic or pancreatic diseases. Alanine transaminase (AST), aspartate transaminase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), amylase and lipase were estimated in all 300 study subjects. Results: There was a significant decrease in the levels of AST and ALT and increase in ALP, GGT, amylase and lipase levels in the CKD patients without ESRD and ESRD patients as compared to the controls (p < 0.05). eGFR was found to have a strong negative correlation with ALP, amylase, and lipase in CKD patients without ESRD and with ESRD. Conclusion: Our study emphasizes that, using the present reference ranges for these enzymes in CKD patients will result misdiagnosis of hepatic or pancreatic disease, hence emphasizing the need to establish new reference ranges for these enzymes in various stages of CKD which ultimately will help the treating physicians in diagnosis and management of hepatic and pancreatic dysfunction in CKD patients.
Gurupadappa K, Geetha Bhaktha, Manjula B, Parameshwara , Prashanth S
Prevalence of Prediabetes at the Tertiary Healthcare Center, McGann Teaching District Hospital, Shivamogga, Karnataka, India
Keywords: Combined, Isolated impaired fasting glucose, Prediabetic
How to cite this article: K G, Bhaktha G, B M, P, S P. Prevalence of Prediabetes at the Tertiary Healthcare Center, McGann Teaching District Hospital, Shivamogga, Karnataka, India. Indian J Med Biochem 2019; 23 (1):213-216.
Aim: The aim of this study was to assess the prevalence of prediabetic state among the people with no clinical symptoms of hyperglycemia and factors underlying the risk of prediabetes. Materials and methods: Patients visiting medicine outpatient department (OPD) were recruited for the study at the tertiary healthcare center, McGann Teaching District Hospital, Shivamogga. Data regarding the health-related status and other risk factors were collected between May 2016 and April 2017. In this cross-sectional study, factors related to the risk of diabetes were analyzed and tabulated. Results: The prevalence of prediabetes was 0.17%, out of which 36.36 % were male, and 63.64% were females, respectively. Participants had a mean age of 47.45 ± 9.95 years, with a higher percentage of people under IFG (39%). The average BMI was 24.44 ± 3.89 with more percent of subjects in impaired fasting glucose (IFG) are having a BMI 25–29.9. Conclusion: Future intervention should include strategies to address social isolation and also focus on middle-aged subjects with the low socioeconomic state. Knowledge enhancement program is warranted for the prevention of prediabetes in this population.
Rama K Reddy YV, Srilakshmi P, KM Cherian, Sai Babu
Comparison of Serum and Salivary Neopterin with Troponin-I and CK-MB Levels in Acute Coronary Syndrome
Keywords: Acute coronary syndrome, High-performance liquid chromatography, Noninvasive, Salivary neopterin, Salimetrics oral swab
How to cite this article: YV RK, P S, Cherian K, Babu S. Comparison of Serum and Salivary Neopterin with Troponin-I and CK-MB Levels in Acute Coronary Syndrome. Indian J Med Biochem 2019; 23 (1):217-220.
Objective: To determine the levels of serum and salivary neopterin in acute coronary syndrome (ACS) in comparison with established biomarkers like Troponin-I and CK-MB. Background: Neopterin is the product of activated macrophage which is released by activated monocyte by cytokines during the acute phase response of ACS, can be used as a biomarker for diagnosis of ACS. Materials and methods: ACS (n = 675) individuals with or without ST-segment elevation myocardial infarction were enrolled for the study, for three years. Serum and saliva neopterin were estimating by HPLC and compared with established biomarkers like Troponin-I and CK-MB. Results: Increased serum and salivary neopterin levels were observed in patients with STEMI, NSTEMI, and UA of ACS. From the ROC analysis serum and salivary neopterin were found to be more sensitive and specific than the established biomarkers of ACS like Troponin-I and CK-MB, in diagnosing ACS. Conclusion: Neopterin being more sensitive and specific than troponin and CK-MB, can be a marker of ACS. The collection of saliva being Non-invasive salivary neopterin can be easily estimated than serum neopterin.
Kusuma KS, Vanitha Gowda MN, Vasudha KC, Radhika K
A Study Comparing Values of Serum Potassium Estimated by Colorimetric KIT Method with those Obtained by Direct and Indirect ION Selective Electrode Methods
Keywords: Bland Altman analysis, Colorimetry, Direct ISE, Indirect ISE, Potassium, Regression, Simple linear
How to cite this article: KS K, MN VG, KC V, K R. A Study Comparing Values of Serum Potassium Estimated by Colorimetric KIT Method with those Obtained by Direct and Indirect ION Selective Electrode Methods. Indian J Med Biochem 2019; 23 (1):221-225.
Introduction: Electrolyte abnormalities are treatable, but known to cause significant morbidity and mortality amongst the general population seeking health care services. The instruments with Ion selective electrode (ISE) (direct or indirect ISE) are the reference methods which are unavailable in rural health care facilities. Materials and methods: A prospective study was undertaken with 120 serum samples. Potassium was estimated using direct, indirect ion-selective electrodes ISE and colorimeter. Statistical analysis was done using statistical package for social sciences (SPSS) version 17, NCSS 11 and MINITAB 18 software. A p < 0.05 was considered statistically significant. Results: A strongly positive correlation for potassium values between the instruments was noted. A simple linear regression analysis was done and a regression equation was derived for potassium values while comparing between the instruments. The Bland Altman analysis with 95% Limits of agreement was computed for potassium values between the instruments. It was well within the CLIA suggested target value ± 0.5 mmol/L for potassium. Conclusion: The values of potassium estimated on the colorimeter are comparable with direct and indirect ISE in all the ranges. The derived regression equation calculates a predicted value for direct and indirect ISE using the values obtained on the colorimeter. This will be beneficial in identifying the altered levels of potassium in patients attending the peripheral health centers, use appropriate intervention and thereby reduce the morbidity and mortality with the use of a cost-effective and logistically feasible instrument viz., colorimeter.
Samarpita Mukherjee, Arup K Banerjee, Swati Bhattacharyya, Shubhrajit Saha
Silent Gallbladder Stone Associated with Nonalcoholic Fatty Liver Disease in a Scenario of Insulin Resistance in Young Adults
Keywords: BMI, Dyslipidemia, Hyperinsulinemia, Gallstone disease, Insulin resistance, Metabolic syndrome, NAFLD
How to cite this article: Mukherjee S, Banerjee AK, Bhattacharyya S, Saha S. Silent Gallbladder Stone Associated with Nonalcoholic Fatty Liver Disease in a Scenario of Insulin Resistance in Young Adults. Indian J Med Biochem 2019; 23 (1):226-229.
Nonalcoholic fatty liver disease (NAFLD) is considered as the hepatic expression of insulin resistance. The high occurrence of obesity and dyslipidaemia in insulin resistant condition favours NAFLD. The hepatic effect of insulin resistance are diverse including increased hepatic cholesterol secretion, biliary cholesterol supersaturation and decreased biliary motility all of which leads to gallstone formation. NAFLD and gallstone disease (GSD) shares common pathological factors like hyperinsulinemia, dyslipidaemia. As all the factors are common association with Insulin resistance there could be common occurrence of NAFLD and GSD in patients with insulin resistance. During a study two patients with insulin resistance were found to have both NAFLD and GSD. Both the patients were found to be dyslipidemic and on sonography one was found to have multiple gall bladder stones and the other with a single gall bladder stone.
Unexplained Extremely High Creatine Kinase-MB Levels in a Cancer Patient with No Chest Pain
Keywords: Creatine kinase, CK-MB, Myocardial infarction
How to cite this article: Yadav A. Unexplained Extremely High Creatine Kinase-MB Levels in a Cancer Patient with No Chest Pain. Indian J Med Biochem 2019; 23 (1):230-231.
Creatine kinase-MB (CK-MB) is a widely evaluated testing enzyme in diseases related to cardiac or injury. Here we relate a clinical scenario of a patient presenting with no chest pain or symptom related to the cardiac disease whose CK-MB levels were remained inordinately elevated despite normal total CK levels. Clinically and subsequent pathological examination showed no evidence of infarction, inflammation or cardiac ischemia. Further evaluation of the patient reveals the presence of the primary prostate carcinoma with the secondary metastatic lesions in the hepatic lobe.


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text:
True Blue (Bonus Tracks) [2001 Remaster]
While Like A Virgin established Madonna as an '80s MTV icon, True Blue, her third album, ensured she was no flash in the pan. Bad movies would jeopardize her star-power somewhat, but the dancefloor was always Madonna's refuge and her image was always up for changing. This time it's thick eyebrows and short, smart blonde locks. Still, a dancefloor diva is not necessarily a worldwide superstar yet, and True Blue works with greater ambition. The dance grooves are meatier. "Open Your Heart" is unstoppable and immediate. "La Isla Bonita" tweaks a Latin rhythm. "Where's the Party" plays up a carefree hedonist rave. But "Live to Tell" is the ballad open for contemplation and in search of beauty. "Papa Don't Preach" is the controversial "keepin' my baby" story-song of a young teen in conflict with parental authority, while "True Blue" pays homage to tough '60s girl groups. As someone well-known for her image, Madonna used True Blue to also build her music.
La Isla Bonita
Jimmy Jimmy
Love Makes the World Go Round
True Blue (The Color Mix)
La Isla Bonita (Extended Remix)
℗ 1986 Warner Records Inc.
True Blue (35th Anniversary Edition)
More by Madonna
The Immaculate Collection
Celebration (Deluxe Version)
Madame X (Deluxe)
Confessions on a Dance Floor
Evita (Highlights from the Motion Picture)
Like a Prayer
Madonna Essentials
'80s Summer Hits
Madonna: Love Songs
Madonna: Deep Cuts
Exposé: Greatest Hits
Laura Branigan
The Essential Cyndi Lauper
Taylor Dayne: Greatest Hits
Taylor Dayne


text:
Goal Attainment Scaling
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Goal Attainment Scaling Form
Goal Attainment Scaling Goals
Goal 1: Goal 2: Goal 3:
ICF-CY
Level of Attainment
Much less
than expected
Somewhat less
Expected level
of outcome
Somewhat more
Source: Janette McDougall, Thames Valley Children's Centre
Goal Area:
ICF-CY Component:
Time Line:
List of Chapters in the ICF-CY, their Level-One Codes, and Basic Content
Body Functions/Impairments
b1. Mental functions (temperament, energy, attention, memory, emotion, cognition)
b2. Sensory functions and pain (seeing, hearing, taste, smell, touch, pain)
b3. Voice and speech functions (articulation, fluency)
b4. Functions of cardiovascular, haematological, immunological, respiratory systems
b5. Functions of the digestive, metabolic, and endocrine systems
b6. Genitourinary and reproductive functions
b7. Neuormusculoskeletal and movement-related functions (involuntary, reflex, gait)
b8. Functions of the skin and related structures (skin, hair, nails)
Activity and Participation/Activity Limitations and Participation Restrictions
d1. Learning and applying knowledge (thinking, reading, writing, calculating)
d2. General tasks and demands (daily routines, handling stress, managing behaviour)
d3. Communication (receptive, productive, using communication devices)
d4. Mobility (changing positions, dexterity, walking, moving, using transportation)
d5. Self care (caring for body, dressing, eating, looking after health/safety)
d6. Domestic life (shopping, household tasks)
d7. Interpersonal relationships (informal and formal relationships)
d8. Major life areas (education, work, engagement in play)
d9. Community, social, and civic life (community/social activities, recreation/leisure)
e1. Products and technology (availability of products and technology)
e2. Natural environment and human-made changes (terrain, climate, air quality)
e3. Support and relationships (informal and formal support)
e4. Attitudes (attitudes of others toward individual)
e5. Services, systems, and policies (health, economic, political, legal, housing, etc.)
GOAL ATTAINMENT SCALING:
Description, Utility, and Applications
in Pediatric Therapy Services
Resource Book/
Prepared By:
Janette McDougall, Ph.D.
Research Associate, Thames Valley Children's Centre,
Tel: 519-685-8680, ext. 53377
Email: Janette.McDougall@tvcc.on.ca
Gillian King, Ph.D.
Research Scientist, Child and Parent Resource Institute,
Email: kinggi@ontario.ca
© 2007 McDougall & King
Goal Attainment Scaling (GAS) is becoming an increasingly popular
technique for evaluating the functional goal attainment of children
receiving pediatric therapy services. This manual is intended as a
resource for clinicians, administrators, and researchers who would like
to use GAS to monitor change over time for individual clients and/or to
evaluate the effectiveness of programs and services.
The authors of this manual have provided training to small and large
groups of clinicians seeking to use GAS for clinical purposes. The
authors have also conducted program evaluation studies of pediatric
therapy services using this individualized measurement approach.
We hope that the information provided here will be helpful to you when
using GAS. We also invite you to contact us at Thames Valley
Children's Centre, tel: 519-685-8680, ext. 53377, or by email:
research@tvcc.on.ca, if you require further information.
Janette McDougall
Thames Valley Children's Centre
Brief History of Goal Attainment Scaling (GAS)..........................................1
Use of GAS in Pediatric Therapy Services....................................................1
Description of GAS .......................................................................................4
Merits of GAS................................................................................................5
Potential Limitations of GAS ........................................................................6
Guidelines for Using GAS.............................................................................7
Number of Goals to Set ......................................................................................... 7
Determining Who Sets Goals ............................................................................... 7
Minimizing Bias in Goal Setting .......................................................................... 8
Criteria for Writing Goals in GAS Format ............................................................ 9
Rating Goals After Intervention ........................................................................ 11
Demonstrating the Reliability of the GAS Rating Procedure ............................ 12
Using GAS for Program Evaluation ............................................................13
Appendix A - GAS Training Procedures ..........................................................14
Appendix B - Common Errors in Writing GAS Scales .......................................15
Appendix C - GAS Checklist..........................................................................18
Appendix D - Examples of GAS Scales in Pediatric Therapy ..............................19
References....................................................................................................28
Goal Attainment Scaling (GAS)
• GAS was first developed by Kiresuk & Sherman (1968) and used
to evaluate mental health programs
• In 1969, the National Institute of Mental Health provided funding
to develop, implement, and disseminate GAS
• GAS has since been used in evaluating service delivery in many
fields (e.g., rehabilitation, education, medicine, corrections,
nursing, and social work)
• Kiresuk et al. (1994) have written a book which serves as both a
user manual and reference work for GAS
Use of GAS in Pediatric Therapy Services
• GAS has been used in several studies of the effects of pediatric
therapy services for children with developmental, physical, and
communication needs (e.g., Brown, Effgen, & Palisano, 1998;
Ekström, Johansson, Granat, & Carlberg, 2005; King et al., 1998;
King, McDougall, Tucker et al., 1999; Palisano, Haley, & Brown,
1992; Palisano, 1993; Steenbeek, Meester-Delver, Becher, &
Lankhorst, 2005; Stephens & Haley, 1991)
© McDougall & King, 2007 1
Brown et al. (1998)
• Examined the effects of physical therapy intervention on attaining gross motor goals in
24 individuals aged 3 to 30 years with severely limited physical and cognitive abilities
• GAS was used to measure change in gross motor ability after 18 weeks of twice-weekly
therapy intervention
• 3 goals were set for each participant, with one goal randomly selected as a control goal
• Participants' improvement on goals was assessed during therapy, recess and at home
• GAS indicated that participants demonstrated improvement during therapy, which did
not consistently transfer to the recess and home settings
• Participants showed greater improvement on treatment goals than on control goals
during therapy, but there were no differences between treatment and control goals
during recess and at home
Ekström et al. (2005)
• Evaluated functional training for children with cerebral palsy using GAS
• The intervention was carried out in the context of natural settings
• 14 children aged 6 months to 6 years participated in the 5-month intervention
• 77% of goals were attained
King et al. (1998)
• One objective of this feasibility study was to examine the utility of GAS for evaluating
therapy services provided to children with special needs in the regular school setting
• 16 children receiving an average of 13 therapy sessions over 4 to 5 months had 1 to 3
functional goals set in one of 3 target areas: communication, productivity, or mobility
• Findings showed that all children made improvements on their goals
• Study concluded GAS was a responsive measure of children's functional change in the 3
target areas and was appropriate for evaluating therapy outcomes in the school setting
King, McDougall, Tucker et al. (1999)
• One objective of this program evaluation study was to use GAS to measure the extent to
which children with special needs achieved their individual, functional goals in the
school setting
• 50 children received an average of 17 therapy sessions throughout the school year
• Each child worked toward 1 to 2 goals set in one of the following target areas:
communication, productivity, or mobility
• Findings showed that 98% of the children made improvement on their functional goals
after receiving intervention, and maintained that improvement 5 to 6 months later
Palisano et al. (1992)
• Tested sensitivity of GAS to measure change and involved 65 infants 3 to 30 months old
with motor delays as measured by the Peabody Developmental Motor Scales (PDMS)
• Therapists set 2 motor goals per infant prior to a 6 month intervention period
• Findings showed that the infants scored higher than expected at the end of intervention
• Study results support the validity of GAS as a responsive measure of motor change in
infants with motor delays
Palisano (1993)
• Study examined the validity and responsiveness of GAS; GAS was compared to the
• 2 goals were set for 2 consecutive 3 month periods for 21 infants with motor delay
• Study results support the content validity and the responsiveness of GAS, and provide
evidence that GAS and the PDMS measure different aspects of motor development
Steenbeek et al. (2005)
• Evaluated the effect of botulinum toxin type A treatment for children with cerebral palsy
using GAS
• 11 children participated in the study
• Goals were recorded weekly for 14 weeks
• 9 of 11 children showed significant improvement on their goals
Stephens & Haley (1991)
• Study investigated the validity and sensitivity to change of the PDMS and GAS
• 54 children 0 to 3 years old and enrolled in early intervention programs were included
• 1 to 2 goals were set for each child prior to a 6 month therapy period
• PDMS and GAS correlations were low (Stevens and Haley suggest that GAS should not
be highly correlated with developmental tests that apply the same standard to everyone)
• Study concluded that GAS can be used to complement the results of standardized motor
assessment (if using GAS alone, interpret with caution)
Description of GAS
• GAS is an individualized, criterion-referenced measure of change
[see King, McDougall, Palisano, Gritzan, & Tucker (1999) for a
detailed description of GAS]
• GAS involves defining a set of unique goals for a client, and then
specifying a range of outcomes, which reflect concrete activities
• Kiresuk et al. (1994) strongly encourage the use of scales
consisting of five levels of attainment, represented by scores
ranging from -2 to +2
GAS 5-Point Rating Scale
Score Predicted Attainment
-2 Much less than expected outcome
-1 Less than expected outcome
0 Expected outcome after intervention
+1 Greater than expected outcome
+2 Much greater than expected
Merits of GAS
• GAS is criterion-referenced, rather than norm-referenced, making
it responsive to minimal clinically significant changes
• Useful for measuring individual goals
• Useful for evaluating functional goals
• Goals can be written for all levels of functional difficulty identified
by the International Classification of Functioning, Disability, and
Health (World Health Organization, 2001) (i.e., impairment,
activity limitation, participation restriction)
• Promotes cooperative goal setting
• Reflects a client-centred perspective to service delivery
• Yields a numeric score for analysing group performance
Potential Benefits
• Improved conceptualization and delivery of intervention
• Improved clarity of therapy objectives for therapists and clients
• Realistic client and therapist expectations of therapy
• Increased client satisfaction
• Increased motivation of the client toward improvement, provided
by the very existence of the goals
Potential Limitations of GAS
• Reliability ± The reliability of a therapist's judgement of the
impact of intervention
• Validity ± Whether the GAS procedure is measuring what
purports to measure (GAS has been criticized as
being a way for therapists to set easy goals that are
not clinically relevant)
Ways to Improve Reliability
• Involve experienced therapists (at least one year of experience in
program)
• Provide comprehensive training in GAS to therapists (see page 14)
• Ensure goals are well-written
• Use independent raters (i.e., raters who do not have a personal
investment in outcome score) and provide training to raters
Ways to Improve Validity
• Kiresuk et al. (1994) strongly urge that GAS be supplemented with
measures that provide more defensible estimates of post-treatment
status (i.e., standardized measures) to provide a comprehensive
assessment of outcome
• Employ randomly selected control goals (after Brown et al., 1998)
Guidelines for Using GAS
Number of Goals to Set
• Available resources, including time, will influence the number of
goals set for a client within a certain intervention period
• For psychometric reasons, Kiresuk et al. (1994) recommend setting
at least three goals per client
• For practical reasons, studies have set 1 or 2 goals per client (King
et al., 1998; King, McDougall, Tucker et al., 1999; Palisano,
Haley, & Brown, 1992; Palisano, 1993; Stephens & Haley, 1991)
Determining Who Sets Goals
• According to strict research methodology (Cytrynbaum et al.,
1979), the therapist who sets the goals should not be the same
therapist who provides the treatment, as they have a vested interest
in the client achieving the goals
• In actual clinical practice it is most realistic and cost-effective for
the treating therapist to be involved in goal setting (Lewis,
Spencer, Haas, & DiVittis, 1987; Kiresuk et al., 1994)
For example, in the King, McDougall, Tucker et al. (1999) study,
it did not make sense from a clinical standpoint for one therapist
to set the goals in conjunction with the teacher, parent, and child,
and then have a different therapist provide treatment who had not
established rapport with these individuals (such a procedure
would be disruptive to the therapist/client relationship and would
not be an accurate representation of the way school-based
therapy services are provided)
Minimizing Bias in Goal Setting
• Use collaborative goal setting, involving several individuals;
this helps to ensure that the goals are clinically meaningful and
relevant and not just easy goals that therapists set on their own
and can be sure of attaining (Clark & Caudrey, 1986; Stollee et
al., 1999)
o As an example, in King, McDougall, Tucker et al. (1999),
each child's treating therapist, parents, teacher, and when
appropriate, the child him/herself, determined the child's
baseline assessment level (-2) and the expected level of
attainment at the end of intervention (0), then, the treating
therapist and a research assistant determined the –1, +1,
and +2 levels
• Involve "GAS" therapists (not involved in treatment) and a
research assistant (or a person well-trained in GAS) in goal
o In King, McDougall, Tucker et al. (1999), the research
assistant and the "GAS" therapists of the same discipline as
the child's treating therapist reviewed the GAS scales and
made suggestions for improvement
• Use a standardized procedure with set criteria [see GAS
Checklist, page 18, used by King, McDougall, Tucker et al.
(1999)]
Criteria for Writing Goals in GAS Format
Six Basic Requirements: Relevant
Understandable
Attainable
• The basic requirements for well-written goals using the GAS
format are discussed in the literature (see Clark & Caudrey, 1983;
Ottenbacher & Cusick, 1990)
• Specific criteria have been established that will help to ensure that
the basic requirements for well-written goals are met (see King,
McDougall, Palisano et al., 1999)
As a whole, the scale should meet the following criteria:
• Aim for clinically equal intervals between all scale levels
e.g. The jump from +1 to +2 should not require a much larger
change in attainment than the jump from -2 to -1
• Amount of change between levels needs to be clinically relevant
• Improvement should be measured using only one variable of
change (as long as the goal remains meaningful), keeping other
variables constant
e.g. -2 The child walks 100m with platform walker in 8
minutes with two hands on walker to assist with
• the above goal includes three variables: distance, time, and
level of assistance
• decide on one variable by which to measure change in
performance, say time, and hold other variables constant
e.g. 0 The child walks 100m with platform walker in 6
• Specify a time period for achievement of a goal
o Intervention should take place over a set time period, such as
4 to 5 months or a given number of therapy sessions
Each level on the scale should meet the following criteria:
• All rating scale levels should be phrased in the present tense
e.g. The child can .…
• All scale levels should be achievable or realistically possible
• All scale levels should be written as clearly as possible, in concrete
behavioural terms
• All scale levels should specify an observable behaviour
© McDougall & King, 2007 10
Rating Goals After Intervention
• Each person's performance is observed either naturalistically (in
the classroom, hallway, etc.) or on a specific assigned task,
depending on the nature of the goal
• For goals whose attainment cannot be observed under naturally
occurring circumstances, the therapist interacts with the client and
requests performance of the goal
o The therapist orients the child to perform the goal
o If prompting is required, the therapist starts with the expected
(0) level of the scale and prompts performance up or down,
depending on the client's success
• The number of trials each client will be given when attempting
his/her goal should be established
• Brown et al. (1998) allowed up to 3 trials per goal (for children
with severely limited physical and cognitive abilities)
• Consider the view of the person being rated (i.e., the person may
be motivated to perform well for the visiting rater or may act out
inappropriately)
• In order to reduce "hype" regarding the rater's visit, inform the
client in advance of the visit and assure the client that regular
performance is what is called for
• The rater should be unobtrusive (maintain a low profile)
• If the client whose performance is being rated is a child, it is
recommended that the original "GAS" therapist confer with the
child's parents/guardians and, when appropriate, the child's
teacher, to reach consensus on the child's goal attainment
• The "GAS" therapist can arrange a meeting or a phone
conversation to discuss the child's progress on each goal
• Conferring with others about a child's performance will give
assurance of rating accuracy, however, the final rating to be used
for evaluation purposes should be that made by the "GAS"
Demonstrating the Reliability of the GAS Rating Procedure
• It is recommended that GAS scores be examined for inter-rater
reliability to establish absence of bias
o Inter-rater reliability is determined by correlating the ratings
of the original " GAS" therapists" with a second "GAS"
therapist on random sub-sample of goals [King, McDougall,
Tucker et al. (1999) correlated the ratings of 30% of study
goals]
o The two "GAS" therapists should rate the goals on the same
occasion (independently), or one of the raters could observe
the therapy session and the other rater observe a video tape of
Using GAS for Program Evaluation
• For program evaluation purposes, users of GAS need to calculate a
summary score to reflect the overall goal attainment of clients
o The recommended procedure is to convert clients' outcome
scores on all their goals into aggregate T- scores that can be
summarized, using a statistical software package like
Statistical Package for the Social Sciences (SPSS) [see
Cardillo & Smith (1994) for a discussion of T-scores and
other summary scores]
o Aggregate T-scores facilitate reliability analyses,
comparisons across clients and comparisons with
standardized measures
o Aggregate T-scores for each client can be computed using the
formula developed by Kiresuk and Sherman (1968):
(10 Σ WiXi)
T = 50 +
(1 - r ) Σ Wi2 + r (Σ Wi2)
o In this formula, 50 represents the mean, 10 the standard
deviation, Wi the weighting for a particular goal [Cardillo &
Smith (1994) strongly recommend against weighting goals],
Xi the score for each goal, and r the expected overall
intercorrelation among outcome scores (the formula
assumes a correlation among goals of .30)
o This formula may appear time-consuming and difficult to use,
but the need for manual computation is rare (if goals are not
weighted and the suggested intercorrelation of .30 is used,
tables are available that allow the quick and easy conversion
of outcome scores into T-scores (see Kiresuk et al., 1994)
Appendix A - GAS Training Procedures
All Therapists General Orientation (2 hours)
• Orientation session
• Handout/Manual
Treating Therapists Skill Acquisition (3 hours)
• Small group practice
• One-to-one guidance with trainer
Skill Maintenance (2 hours)
• Continued monitoring of goal setting
• Question and answer sessions
Rating Therapists Skill Acquisition (4 hours)
- Goal Rating
• Review goals with trainer
• peer review of goal writing
• familiarizing raters with the
goals that they will be rating
• Review of goal rating procedure
Skill Maintenance (1 hour)
Appendix B - Common Errors in Writing GAS Scales
Error Description Solution
Overly If the expected level (i.e., 0 The expected level of a
Generalized level) of a scale is written in scale should be written
Goals very general terms (e.g., "the as clearly as possible
client walks a greater distance (e.g., "the client walks
in a set period with with platform walker
assistance"), it will be difficult 100 metres in six
or impossible to create the minutes with two hands
remaining scale points on walker to assist with
steering").
Overly A goal setter may use terms Write goals in common
Technical specific to his/her profession in terms, especially if the
Goals creating a scale that the goal rater and goal setter
rater is not familiar with. differ in professional
backgrounds.
Multiple A scale may include two or Decide on one variable
Variables of more variables of change. This by which to measure
Change could be problematic if the change and hold others
scale is written so that constant. If, in doing so,
improvement is expected to the goal does not
occur simultaneously on these remain clinically
variables. meaningful, two (or
more) variables could
change within in a
single scale, provided
that improvement is not
expected to occur
simultaneously on these
variables.
Unequal Scale A scale may be created where Aim for clinically equal
Intervals the amount of clinical change intervals between all
is greater between, say, the +1 levels of the scale.
and +2 levels than the amount
of change between the -2 and
-1 levels.
Clinically A scale may be created where The amount of change
Irrelevant or one or more of the levels between all scale levels
Unrealistic represents an amount of change needs to be clinically
Scale Levels that would not be clinically relevant and all levels
relevant (i.e., amount of change should be achievable
is too small to matter) or for the client.
amount of change is unrealistic
for the client (i.e., amount of
change is too great).
Using A GAS scale may be written All scale levels should
Different with the -2 level written in one be phrased in the
Tenses (i.e., tense and all other levels in present tense, in order
Past, Present, another tense, which could be for evaluation to make
Future) When confusing and bias the goal sense at different time
Writing Scale rater. points (i.e., "the client
Levels can ...").
Redundant or A scale may be written where a Be careful not to create
Incomplete client could be scored on two scale levels that are
Scale Levels levels at the same time (e.g., redundant or
the +1 level has walking incomplete. Careful
distances specified between wording (e.g., +1 would
"40 and 50 metres" and the +2 be "more than 40
level specifies distances metres and up to 50
between "50 and 60 metres". If metres" and +2 would
a client walks exactly 50 be "more than 50
metres, both the +1 and the +2 metres and up to 60
level would be correct. On the metres" or specific
other hand, a gap could be instructions to the rater
present in the scale where a (e.g., if a client obtains
client could not be scored on a midway point
any level (e.g., the +1 specifies between two levels,
walking distances between "40 score the client at the
and 50 metres" and the +2 lower level) will be of
specifies distance between "60 benefit.
and 70 metres"; if a client
walks 55 metres, neither +1 nor
+2 is correct).
Baseline Level A scale may be written with -2 When no deterioration
is Set at as the baseline when a client is expected in client's
Inappropriate has a progressive, chronic performance, -2 can be
Level condition. This scale would not defensibly used as the
capture any deterioration in client's baseline. When
condition. evaluating the
performance of clients
with progressive
conditions who may
deteriorate in function
over time, it would
make sense to set the
baseline at -1, leaving
room for deterioration
over the intervention
Blank Scale It may be difficult to write the Be careful to set goals
Levels more extreme levels of a scale, where it is possible to
tempting the goal setter to complete all scale
leave these levels blank. If a levels.
client happens to achieve an
upper or lower extreme, it
would be impossible to rate the
client's performance.
Appendix C - Goal Attainment Scaling Checklist
Name of Participant:
• Therapy Goal: Expected Outcome (i.e., a score of 0)
As a whole, the scale must meet the following criteria:
Criteria Criterion Criterion Comments
Met Not Met
Amount of change between levels is
clinically important
There are approximately equal intervals
between levels
There is a set time period for goal
Scale reflects a single variable of
change (or, if not feasible, each level
reflects a single variable of change)
Each level on the scale must meet the following criteria:
Be written in concrete behavioral terms
Specify an observable behavior
Be written in the present tense
Be achievable or realistically possible
Appendix D - Examples of Goals Written in GAS Format
Example 1 of GAS Scale for Physical Therapy
Therapy Discipline: Physical Therapy
Target Area: Movement Functions
Sub-category: Control of Voluntary Movement Functions
Functional Level: Impairment
Time Line: 5 months
Goal Attainment Rating Scale:
-2 The client is able to lift his head and right arm when
attempting to roll from supine to prone over his left side.
-1 The client is able to roll half way from supine to prone over his
left side (and attain left-side lying).
0 The client is able to roll from supine to prone over his left side.
+1 The client is able to roll from supine to prone and half way
back to supine over his left side (and attain left-side lying).
+2 The client is able to roll from supine to prone and back to
supine over his left side.
Target Area: Mobility
Sub-category: Moving Around Using Equipment
Functional Level: Activity Limitation
-2 The client walks with walker from library to classroom in 6
minutes, with supervision and verbal cueing.
-1 The client walks with walker from library to classroom within
4 to 5 minutes, with supervision and verbal cueing.
0 The client walks with walker from library to classroom in 3
minutes or less, with supervision and verbal cueing.
+1 The client walks with walker from library to classroom in 3
minutes or less, with supervision and no verbal cueing.
minutes or less independently (no supervision and no verbal
cueing.
Note: if client walks a distance that falls between scale levels (e.g.,
5.5 minutes), the client will be rated at the lower scale level
Sub-category: Moving Around
Functional Level: Participation
Time Line: 10 months
-2 The client takes part in gym class for 10 minutes, with
standby assistance.
0 The client takes part in gym class for 20 minutes, with standby
assistance.
+1 The client takes part in gym class for 25 minutes, with standby
Note: if client takes part for a time that falls between scale levels
(e.g., 17 minutes), the client will be rated at the lower scale
Example 1 of GAS Scale for Speech-Language Pathology
Therapy Discipline: Speech-Language Pathology
Target Area: Voice and Speech Function
Sub-category: Articulation
-2 The client produces "f" with 90% accuracy at the imitated
sound level.
-1 The client produces "f" in final word position with 90%
accuracy at the imitated word level.
0 The client produces "f" in final word position with 90%
accuracy at the spontaneous word level.
+1 The client produces "f" in final word position with 90%
accuracy at the imitated sentence level.
accuracy at the spontaneous sentence level.
Target Area: Communication
Sub-category: Speaking
-2 The client reads a short passage aloud, making 10 or more
pronunciation errors.
-1 The client reads a short passage aloud, making between 9 and
7 pronunciation errors.
0 The client reads a short passage aloud, making between 6 and
+1 The client reads a short passage aloud, making between 3 and
+2 The client reads a short passage aloud, pronouncing all words
correctly.
Sub-category: Conversation
Functional Level: Participation Restriction
-2 The client responds to questions from the teacher by shaking
or nodding her head throughout the school day.
-1 The client verbally responds to 1 question from the teacher
throughout the school day.
0 The client verbally responds to 2 questions from the teacher
+1 The client verbally responds to 3 questions from the teacher
+2 The client verbally responds to 4 or more questions from the
teacher throughout the school day.
Example 1 of GAS Form for Occupational Therapy
Therapy Discipline: Occupational Therapy
-2 The client is able to grasp a small object with dominant hand
and hold on to it for no more than 5 seconds.
and hold on to it for 10 seconds.
0 The client is able to grasp a small object with dominant hand
+1 The client is able to grasp a small object with dominant hand
and hold on to it for 25 seconds or more.
Note: if client grasps object for a period of time between scale levels
(e.g., 22 seconds), the client will be rated at the lower scale
Target Area: Learning and Applying Knowledge
Sub-category: Learning to Write
-2 The client forms 5 of the 26 cursive letters correctly during
one on one supervision.
-1 The client forms between 6 to 10 of the 26 cursive letters
correctly during one on one supervision.
0 The client forms between 11 and 25 of the 26 cursive letters
+1 The client forms between 16 and 20 of the 26 cursive letters
Sub-category: Hand and Arm Use
-2 The client plays "catch" with a classmate at recess for less
than 1 minute, without dropping the ball.
-1 The client plays "catch" with a classmate at recess for more
than 1 and up to 2 minutes, without dropping the ball.
0 The client plays "catch" with a classmate at recess for more
+1 The client plays "catch" with a classmate at recess, for more
+2 The client plays "catch" with a classmate at recess for more
Brown, D. A., Effgen, S. K., & Palisano, R. J. (1998). Performance following ability-
focused physical therapy intervention in individuals with severely limited
physical and cognitive abilities. Physical Therapy, 78, 934-947.
Cardillo, J.E, & Smith A. (1994). Psychometric issues. In T. Kiresuk, A. Smith, & J.
Cardillo (Eds.), Goal attainment scaling: Applications, theory, and measurement
(pp. 173-212). Hillsdale, NJ: Lawrence Erlbaum Associates.
Cytrynbaum, S., Ginath, Y., Birdwell, J., & Brandt, L. (1979). Goal attainment scaling:
A critical review. Evaluation Quarterly, 3, 5-40.
Ekström, L., Johansson, E., Granat, T., & Carlsberg, E. (2005). Functional therapy for
children with cerebral palsy: An ecological approach. Developmental Medicine
and Child Neurology, 47, 613-619.
King, G., Tucker, M., Alambets, P., Gritzan, J., McDougall, J., Ogilvie, A., Husted, K.,
O'Grady, S., Malloy-Miller, T., & Brine, M. (1998). The evaluation of functional,
school-based therapy services for children with special needs: A feasibility study.
Physical and Occupational Therapy in Pediatrics, 18, 1-27.
King, G., McDougall, J., Tucker, M., Gritzan, J., Malloy-Miller, T., Alambets, P.,
Gregory, K., Thomas, K., & Cunning, D. (1999). An evaluation of functional,
school-based therapy services for children with special needs. Physical and
Occupational Therapy in Pediatrics, 19, 5-29.
King, G., McDougall, J., Palisano, R. J., Gritzan, J., Tucker, M. (1999). Goal attainment
scaling: Its use in evaluating pediatric therapy programs. Physical and
Occupational Therapy in Pediatrics, 19, 30-52.
Kiresuk, T. J., & Sherman, R. E. (1968). Goal attainment scaling: A general method for
evaluating comprehensive community mental health programs. Community
Mental Health Journal, 4, 443-453.
Kiresuk, T. J., Smith, A., & Cardillo, J. E. (1994). Goal attainment scaling:
Applications, theory, and measurement. Hillsdale, NJ: Lawrence Erlbaum
Associates.
Lewis, A. B., Spencer, J. H., Haas, G. L., & DiVittis, A. (1987). Goal attainment
scaling: Relevance and replicability in follow-up of inpatients. The Journal of
Nervous and Mental Disease, 175, 408-417.
Ottenbacher, K. J., & Cusick, A. (1993). Discriminative versus evaluative assessment:
Some observations on goal attainment scaling. The American Journal of
Occupational Therapy, 47, 349-354.
Palisano, R. J., Haley, S. M., & Brown, D. A. (1992). Goal attainment scaling as a
measure of change in infants with motor delays. Physical Therapy, 72, 432-437.
Palisano, R. J. (1993). Validity of goal attainment scaling with infants with motor
delays. Physical Therapy, 73, 651-658.
Steenbeek, D., Meester-Delver, A., Becher, J., & lankhorst, G. (2005). The effect of
botulinum toxin type A treatment of the lower extremity on the level of functional
abilities in children with cerebral palsy: evaluation with goal attainment scaling.
Clinical Rehabilitation, 19, 274-282.
Stephens, T. E., & Haley, S.M. (1991). Comparison of two methods for determining
change in motorically handicapped children. Physical and Occupational Therapy
in Pediatrics, 11, 1-17.
Stollee, P., Zaza, C., Pedlar, A., & Myers, A. M. (1999) Clinical experience with goal
attainment scaling in geriatric care. Journal of Aging and Health, 11, 96-124.
World Health Organization. (2001) ICF. International Classification of Functioning,
Disability and Health. Geneva: World Health Organization.
Validity (Statistics)
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Most Conventional companies advise their customers to acquire responsive web design for use on mobile devices. This feature allows these companies to bill more charges because of the extensive mobile web design process involved in converting the website to a convertible type.
Zartash however does not believe in the philosophy of overcharging its customers. Hence in certain situations such as different strategy goals and content the company advises the customers to acquire a mobile website. Whenever a customer browses a website using a mobile device, he will be redirected to the mobile version which is much simpler and adapted for resolution of mobile devices.
These optimization features allow the website to save a lot of space thus making the website accessible faster than normal devices.
The first step for Mobile Web Design Process by Zartash is simply having professional content writers who create as much to-the-point content as possible. The reason of this approach is our research which suggests that 58% users are less likely to read a longer excerpt that a shorter one on a mobile website. On a computer screen, the same ratio is found to be 44% thus indicating the importance of being brief.
As a part of the shortening strategy, Sections are converted into Single Sheets; Para's are edited into Statements. Multiple attempts at editing are made to ensure that the content is as minute as possible. Although this process is complicated but not for you! , You can leave it all up to Zartash's expert content writers.
Zartash has researched to discover that there are multiple features which work with enhanced eloquence on mobile screens. Such features include.
Navigation maps allow smoother usage due to their aspect ratio features which can load faster on mobile devices due to smaller screen size and hence smaller aspect ratios.
Blogs function smoothly due to the format of data present in them. The text is presented mostly as a paragraph whereas pictures are separated into drop boxes; the same strategy is applied for videos.
Newsfeeds can be arranged into a text and picture link format where pictures are hosted on another remote server and are opened via third party software only upon selection.
The format of photo galleries is altered to produce a faster presentation of the pictures. The file type is changed to a shorted more compressed version, reducing the size and accessing time.
Video Libraries are organized into collections of Streaming links that are connected to mobile optimized videos uploaded on Zartash's servers thus reducing the websites loads to near zero on video and the load is only enhanced upon the event of selection of link where a third party application connected video to streaming server directly.
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The Kansas City Metropolitan Area is a fifteen-county area that is anchored by Kansas City, Missouri and is bisected by the border between the states of Missouri and Kansas. As of the 2010 Census, the metropolitan area has a population of 2,035,334.
Kansas City is experiencing renewed market conditions with an average sale price increase of 9.1% increase compared to the year 2012. Residential total sales level (new and existing homes) represent a 9.2% increase compared to the year 2012. The monthly supply of homes of 4.7 months represents a competitive market for combined new and existing homes. Unemployment rates has declined from 6.6% to 5.6%.
Markets priced below $250000 show decreased average sale price of 1.4% (2012-$114890 and 2013-$113255). Real estate markets from $250,000 to $500,000 have increased average sale price of less than 1% (2012-$334575 and 2013-$337136). The markets above $500,000 had increasing sales activity of 25% along with an increasing sale price of less than 1% (2012-$729169 and 2013-$734604). New construction sales activity increased 13% and average sales price increased 8% (2012-$318510 and 2013-$345866).
The historically low mortgage rate, have created a favorable buying environment for those with a job and good credit. Consumer confidence and job security are gradually increasing but remain cautious.
The Kansas City real estate market has lower unemployment, increased sales volume and an increase in prices. The competitive prices are still attracting more buyers and this includes investors. The key ingredient to this market recovery will be job growth. Metro Kansas City is a diversified economy including trade, transportation, utilities, education, communication, government and health services.