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The modified Trait and State Food-Cravings Questionnaires: development and validation of a general index of food craving.

In the present study, the multidimensional Trait and State Food Cravings Questionnaires (FCQ-T and FCQ-S), as developed by Cepeda-Benito, Gleaves, Williams, and Erath, [2000. The development and validation of the State and Trait Food Cravings Questionnaires. Behavior Therapy, 31, 151-173], were modified in order to construct an index of general food craving instead of specific food craving. The factor structure, validity and reliability of the modified questionnaires, renamed as the Trait and State General Food Cravings Questionnaires (G-FCQ-T and G-FCQ-S), were investigated in three separate studies. Firstly, exploratory factor analyses were conducted, which yielded a G-FCQ-T with a four-factor structure, that was considerably shorter as compared to the original (nine-factor) FCQ-T, and a G-FCQ-S of which the factor structure was highly comparable to the original FCQ-S. Secondly, in an attempt to replicate the factor structures of the G-FCQ-T and the G-FCQ-S as found in Study 1, confirmative factor analyses were performed. Results indicated adequate fits for both questionnaires. In addition, the test-retest reliability of both versions was satisfactory and an analysis of the construct validity generally revealed the expected results. In Study 3, the validity of the state version of the G-FCQ was further investigated by relating scores on this questionnaire to indices of food deprivation and satiation. Results indicated that the G-FCQ-S indeed measures food craving as a variable state, which is influenced by situational and temporal variables. Altogether, it can be concluded that the G-FCQ-T and G-FCQ-S are both reliable and valid measures of general trait-like and state-dependent food craving.

Adolescent↗

Reconsidering the Caregiving Stress Appraisal scale: validation and examination of its association with items used for assessing long-term care insurance in Japan.

The Caregiving Stress Appraisal (CSA) scale is a simple scale for measuring family caregiver stress. However, information on its validity and association with new social welfare systems in Japan is inadequate. The purpose of the present study is to examine the criterion validity of the CSA and to explore its association with the variables used for assessing long-term care insurance in Japan. In the present study, 219 family caregivers completed a self-administered questionnaire. Of these, 50 and 202 caregivers were used for the analysis of the criterion validity and construct validity, respectively. The CSA, the Japanese version of the Zarit Burden Interview (J-ZBI), the Center for Epidemiological Studies-Depression (CES-D), and the items used for assessing long-term care insurance in Japan were used for the analyses. The results revealed that the CSA had significant correlations with the J-ZBI and the CES-D. Despite the small sample size, the CSA had significant correlations with the items used for assessing long-term care insurance in Japan. These results suggest sufficient criterion and construct validity of the CSA for the future study.

Aged↗

Dynamic knowledge validation and verification for CBR teledermatology system.

OBJECTIVE: Case-based reasoning has been of great importance in the development of many decision support applications. However, relatively little effort has gone into investigating how new knowledge can be validated. Knowledge validation is important in dealing with imperfect data collected over time, because inconsistencies in data do occur and adversely affect the performance of a diagnostic system. METHODS: This paper consists of two parts. First, it describes methods that enable the domain expert, who may not be familiar with machine learning, to interactively validate knowledge base of a Web-based teledermatology system. The validation techniques involve decision tree classification and formal concept analysis. Second, it describes techniques to discover unusual relationships hidden in the dataset for building and updating a comprehensive knowledge base, because the diagnostic performance of the system is highly dependent on the content thereof. Therefore, in order to classify different kinds of diseases, it is desirable to have a knowledge base that covers common as well as uncommon diagnoses. RESULTS AND CONCLUSION: Evaluation results show that the knowledge validation techniques are effective in keeping the knowledge base consistent, and that the query refinement techniques are useful in improving the comprehensiveness of the case base.

Dermatology↗

Ethological validation and the assessment of anxiety-like behaviours: methodological comparison of classical analyses and structural approaches.

The research on emotional reactivity usually implies the use of standardised behavioural tests that provide a quick idea of the effect of a treatment on the reactivity of subjects to potentially dangerous situations. Many validity criteria have been considered to evaluate these tests. This validity concept supports the idea that animals' behaviour in these tests model human anxiety. Generally, those criteria repeatedly labelled as "ethological validation" refer to the analogy between animals and human in the meaning of the test situation. Although the content of the ethological validation concept is heterogeneous, it is steadily related to a fixed interpretation of the behavioural items produced in a given experimental setting. The basic assumption of such reasoning is that the behavioural items would always be expressed in the same behavioural context whatever the subject, its gender, strain or species, thoroughly asserting a predefined subjective state. Using multivariate and textual analysis, we found evidence that the "ethological validation" recourse to an a priori interpretation for a given behavioural variable may be deceptive. We defend the idea that the meaning of a behavioural variable should be restricted to the general context where it arose. Theoretical propositions and methodological options are discussed.

Animals↗

Validity of a short insomnia questionnaire: the SDQ.

The SDQ is a brief self-report insomnia questionnaire, which permits the rapid evaluation of insomnia based on the DSM-IV and ICSD-R criteria. The SDQ was developed to provide a fast and valid instrument both for the pre-screening of subjects who complain of insomnia and for epidemiological studies based on standardized definitions of this sleep disorder. Two studies were carried out in order to assess the validity of the SDQ as a self-report measure of insomnia. In the first study the convergent validity of the SDQ was assessed with respect to the global score of the Pittsburgh Sleep Quality Index (PSQI) in a sample of general practitioners' patients. The second study assessed the sensitivity and the specificity of the SDQ in discriminating between insomniacs or normal sleepers in a sample of college students who were given an extensive sleep evaluation within an insomnia counseling program. The SDQ classifications have a good convergent validity with the global sleep quality scores of the PSQI and its classifications of students who complain of or who do not complain of problems of insomnia have a sensitivity of 95% and a specificity of 87%. Results indicate that the SDQ is a valid paper and pencil instrument to screen insomnia.

Adult↗

Development and validation of a novel rating system for scoring standing foot posture: the Foot Posture Index.

INTRODUCTION: The limitations of clinical methods for appraising foot posture are well documented. A new measure, the Foot Posture Index is proposed, and its development and validation described. METHODS: A four-phase development process was used: (i) to derive a series of candidate measures, (ii) to define an appropriate scoring system, (iii) to evaluate the validity of components and modify the instrument as appropriate, and (iv) to investigate the predictive validity of the finalised instrument relative to static and dynamic kinematic models. Methods included initial concurrent validation using Rose's Valgus Index, determination of inter-item reliability, factor analysis, and benchmarking against three dimensional kinematic models derived from electromagnetic motion tracking of the lower limb. RESULTS: Thirty-six candidate components were reduced to six in the final instrument. The draft version of the instrument predicted 59% of the variance in concurrent Valgus Index scores and demonstrated good inter item reliability (Cronbach's alpha = 0.83). The relevant variables from the motion tracking lower limb model predicted 58-80% of the variance in the six components retained in the final instrument. The finalised instrument predicted 64% of the variance in static standing posture, and 41% of the variance in midstance posture during normal walking. CONCLUSION: The Foot Posture Index has been subjected to thorough evaluation in the course of its development and a final version is proposed comprising six component measures that performed satisfactorily during the validation process. The Foot Posture Index assessment is quick and simple to perform and allows a multiple segment, multiple plane evaluation that offers some advantages over existing clinical measures of foot posture.

Adult↗

The Japanese version of the Depressive Experiences Questionnaire: its reliability and validity for lifetime depression in a working population.

We have developed a Japanese version of the Depressive Experiences Questionnaire (DEQ), devised by Blatt et al., for assessing depression-prone personality and examined the questionnaire's reliability (test-retest reliability and internal consistency) and validity. To examine the questionnaire's validity, we evaluated its factorial validity and discriminant power for depression (i.e., construct validity). To test the construct validity of the DEQ with and without depression proneness, the scores on the DEQ subscales were compared between subjects with and without a lifetime history of major depressive disorder (MDD). The Inventory to Diagnose Depression, Lifetime version (IDDL), was used to identify lifetime depression. The reliability tests showed that the Japanese version has reliability almost similar to that of the original version. While the self-criticism has good reliability, the dependency appears to have only modest reliability. In the comparisons between subjects with and without lifetime histories of major depression, the former had significantly higher scores on the self-criticism dimension of the DEQ than did the latter, suggesting that the Japanese version of the DEQ, especially the self-criticism, may have the ability to distinguish individuals with lifetime depression from normal controls. We conclude that the DEQ is an acceptable instrument for assessing the depression-prone personality.

Adult↗

Computer-assisted detection for CT colonography: external validation.

AIM: To externally validate a computer-assisted detection (CAD) system for computed tomography (CT) colonography, using data from a single centre uninvolved with the software development. MATERIALS AND METHODS: Twenty-five multi-detector CT colonography examinations of patients with validated polyps accumulated at a single centre were examined by two readers who used endoscopic and histopathological data to identify polyp coordinates. A CAD system that had been developed using data from elsewhere, and had not previously encountered the present data, was then applied to the data at sphericity filter settings of 0.75 and 0.50 and identified potential polyps. True-positive, false-negative, and false-positive counts were determined by comparison with the known polyp coordinates. RESULTS: Twenty-five patients had 57 polyps, median size 6mm (range 1-15mm). Per-patient sensitivity for the CAD system was 96% (24 of 25). The CAD system detected 44 (77%) polyps at sphericity setting 0.75 and 49 (86%) polyps at sphericity 0.50: the additional five polyps detected all measured 5mm or less. Sphericity of 0.75 resulted in a median of 10 (one to 34) easily dismissed false-positive prompts per patient and a median of 4 (zero to 15) that needed three-dimensional rendering before dismissal. This rose to 32 (16 to 99) and 11 (three to 35), respectively, at sphericity 0.5. CONCLUSIONS: A per-patient sensitivity of 96% was found for the CAD system (in patients with a median polyp diameter of 6mm) using external validation, a more stringent test than either internal cross-validation or temporal validation. Decreasing sphericity increases sensitivity for small polyps at the expense of decreased specificity.

Colonic Polyps↗

The Italian version of the Obsessive-Compulsive Drinking Scale: validation, comparison with the other versions, and difference between type 1- and type 2-like alcoholics.

The Obsessive-Compulsive Drinking Scale (OCDS) is a quick and reliable self-rating instrument for alcohol craving. Translated and validated versions are available and all of them have confirmed the utility of the scale in clinical situations. The purpose of this study was to translate and validate the Italian version of the OCDS, to assess its psychometric properties, to compare it with the other versions, and to search for possible differences between subgroups distinguished according to socio-demographic and clinical variables. The OCDS and a visual analogue scale (VAS) for alcohol craving were given to 103 Italian-speaking alcohol-dependent patients, who were assessed for their typology of alcoholism according to Cloninger's criteria. The reliability, the correlations between the variables and the influence of other factors were measured. Principal component analysis was performed to detect underlying dimensionality of the scale. The construct validity of the total scale and the subscales, as tested with Cronbach alpha analysis, was good. The r-values between total (TOT) and obsessive (OB) and compulsive (CP) subscales were comparable with those obtained in the other European studies. None of the socio-demographic parameters, nor the majority of the clinical factors significantly influenced the OCDS scores; however, there was a significant difference in total and subscale scores between Cloninger's "type 1-like" and "type 2-like" alcoholics, with the former having lower scores than the latter ones, whereas the VAS was not able to discriminate them. Principal component analysis of the 14 OCDS items showed that the scale is better described by a three-factor solution. The Italian version of the OCDS exhibited good reliability and construct validity, confirmed its psychometric properties, showed higher scores than in other studies, showed CP consistently higher than OB score, confirmed the validity of the French method for score calculation and was able to discriminate Cloninger's "type 1-like" and "type 2-like" alcoholics.

Adult↗

Validation of the WHO Quality of Life assessment instrument (WHOQOL-100) in a population of Dutch adult psychiatric outpatients.

BACKGROUND: Research concerning the psychometric properties of the WHO Quality of Life Assessment Instrument (WHOQOL-100) in general populations of psychiatric outpatients has not been performed systematically. AIMS: To examine the content validity, construct validity, and reliability of the WHOQOL-100 in a general population of Dutch adult psychiatric outpatients. METHOD: A total of 533 psychiatric outpatients entered the study (438 randomly selected, 85 internally referred). Participants completed self-administered questionnaires for measuring quality of life (WHOQOL-100), psychopathological symptoms (SCL-90), and perceived social support (PSSS). In addition, they underwent two semi-structured interviews in order to obtain Axis-I and Axis-II diagnoses, according to DSM-IV. RESULTS: The drop-out percentage was low (7.1%). Of the 24 facets of the WHOQOL-100, 22 had a good distribution of scores, leaving out the facets physical environment and transport. Exploratory factor analysis revealed a four-factor structure, which was similar to earlier findings in patients with specific somatic diseases and depressive disorders. Various-a priori expected-positive and negative correlations were found between facets and domains of the WHOQOL-100, and dimensions of the SCL-90 and the PSSS-score, indicating good construct validity of the WHOQOL-100. The internal consistency of all facets and the four domains of the WHOQOL-100 was good (Cronbach's alpha's ranging from 0.62 to 0.93 and 0.64 to 0.84, respectively). Sparse and relatively low correlations were found between demographic characteristics (age and sex) and WHOQOL-100 scores. CONCLUSIONS: Content validity, construct validity, and reliability of the WHOQOL-100 in a population of adult Dutch psychiatric outpatients are good. The WHOQOL-100 appears to be a suitable instrument for measuring quality of life in adult psychiatric outpatients.

Adult↗

Validity and reliability of a questionnaire for evaluating nocturia, nocturnal enuresis and sleep-interruptions in an elderly population.

OBJECTIVES: To validate a new questionnaire evaluating nocturia, nocturnal enuresis and sleep-interruptions in an elderly population of men and women in Denmark. METHODS: The Nocturia, Nocturnal Enuresis and Sleep-interruption Questionnaire (NNES-Q) emerged from review of the literature and expert consensus. The questionnaire was a subset of a larger questionnaire comprising several domains on health status and voiding. Convergent and discriminatory validity was assessed in an unselected population of 2000 men and 2000 women 60-80 years old. To test reproducibility, 400 respondents were mailed a separate questionnaire 2 weeks apart. A subgroup of men and women with and without nocturia was used for evaluating reliability of number of nocturia episodes. RESULTS: A total of 2825 (70.6%) filled in the questionnaire. A decrease in health status was correlated with increasing bother (range: -0.25 to -0.36, p<0.001, Spearman's r). These findings indicate acceptable convergent validity. Significant discriminatory validity was proven in separate groups of symptom severity (p<0.0001, Kruskal-Wallis test). Median kappa was 0.70 (range 0.58-0.86) indicating substantial agreement in the retest analysis. Number of nocturia episodes in questionnaires correlated with frequency volume charts (Spearman's rho 0.88; p<0.001). CONCLUSION: These data support that the NNES-Q has a good discriminatory and convergent validity, and is reliable over time. The NNES-Q may be useful in epidemiological studies and may also have a potential in daily clinical work up in patients with nocturia and nocturnal enuresis.

Aged↗

Development and validation of a procedure for the determination of minoxidil in hair-regrowth formulations using two variants of capillary zone electrophoresis.

A high performance capillary electrophoresis method was developed and validated for purity assessment of minoxidil bulk drug and for determination of minoxidil in Rogaine. The principal use of the method was in analyzing illicit minoxidil-containing hair-regrowth samples. Although validated for Rogaine, the procedure proved equally viable on illicit minoxidil-containing preparations. The developed method fulfilled the goal of providing an orthogonal technique to HPLC for confirmation of the presence of minoxidil in these imitations. The method was validated on two instruments, one utilizing EK injection, the other gravity injection. It is selective for minoxidil, which is separated from known process impurities and the single degradation impurity. Validation figures of merit for linearity/recovery (accuracy) and precision were in accordance with current expectations for method validation.

Electrophoresis, Capillary↗

Development and validation of the Infertility Self-Efficacy scale.

OBJECTIVE: To develop and validate a scale of perceived self-efficacy for people coping with infertility treatment. DESIGN: Self-efficacy scale development involved: [1] item generation with medical experts in reproductive health; [2] a principal components analysis with varimax rotation to identify underlying item components; [3] test-retest reliability and construct (convergent and discriminant) validity with infertility patients, who were administered the Infertility Self-Efficacy (ISE) scale with other measures; and [4] expert acceptability, as determined by reproductive health professionals. SETTING: Recruitment at a fertility center, a national infertility organization, and medical trials web pages. PATIENT(S): A total of 213 participants (159 women; 54 men) with a diagnosis of infertility in the past 2 years were recruited for the various study phases. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Participants' infertility self-efficacy was assessed with an online assessment battery using the ISE scale; comparison mental health measures assessed current levels of fertility problem distress, perceived stress, and coping style. Reliability, validity, and component structure of the ISE was assessed. RESULT(S): Measurement development yielded a brief 16-item ISE scale that taps an infertility patient's perception about his or her ability to engage in a set of cognitive, emotional, and behavioral skills related to the medical treatment of infertility. The single component of "cognitive/affect regulation" suggests this core set of skills is relevant to successfully managing the experience of infertility. The ISE correlations with comparison mental health measures were as expected, suggesting good convergent and discriminant validity. CONCLUSION(S): The ISE scale appears to be a reliable and valid measure of an individual's self confidence in areas related to health promotion during infertility treatment. Assessing an infertility patients' self-efficacy with the ISE may be useful in clinical research and as a counseling tool to help guide patients in actively managing their fertility treatment.

Adaptation, Psychological↗

The reliability and validity of a new and simple method to measure sedation levels in intensive care patients: a pilot study.

BACKGROUND: Since more sophisticated ventilation techniques have enabled patients to comply with the ventilator with little or no sedation, deep sedation levels can easily be avoided. However, successful ventilation techniques also expanded the treatment possibilities for more severely ill patients who require deeper sedation levels. We developed a new sedation score to improve the prevention of oversedation and to simplify scoring practice in the intensive care unit (ICU). OBJECTIVE: The study's objective was to establish the validity and reliability of a new sedation score (Sedic score) for critically ill, sedated adult patients. METHODS: We prospectively evaluated the reliability and validity of the Sedic score. The study took place in a 30-bed ICU in a university teaching hospital. Forty-six consecutive mechanically ventilated and sedated ICU patients were included. The constructed scale consists of five levels of stimuli and five levels of responses. Sedation levels are defined by the sum of stimulus and response. The reliability of the Sedic score was assessed by simultaneous measurement by the research nurse and attending nurse (n=70). VALIDITY was expressed as (1) the hierarchic relation between stimulus and response (n=443), (2) the prediction of wake-up time by the Sedic score (n=46), and (3) the association between the Sedic score and the Ramsay scale (n=88). RESULTS: The method showed excellent reliability. VALIDITY: Weighted kappa between stimulus and response was .82. Multivariate analysis: (recovery time as independent variable) regression line (Y=-2.53+ 2.16 * beta; P<.001) (r2=42%). Correlation between the Sedic scores and the Ramsay scores was r(s) .74 (P=.01). Sixty-seven percent of the patients with a maximum Ramsay score of 6 had scores ranging between 6 and 10 on the Sedic scale, indicating that the Ramsay scale has a serious ceiling effect. CONCLUSION: The Sedic score demonstrates sufficient reliability and validity, and correlates well with wake-up time. It allows for frequent use by nurses to avoid oversedation in patients.

Adult↗

Reliability and validity of the Faces Pain Scale with older adults.

BACKGROUND: The Faces Pain Scale (FPS) is effective with older adults in clinical assessment of pain intensity. The 0-10 numerical rating scale (NRS) has universally adapted for assessment of pain intensity. The commonly used versions of the FPS have six, seven or nine faces. OBJECTIVES: We proposed an 11 face modified version of the McGrath nine face FPS to compare with the 0-10 NRS without the mathematical translation. The psychometric properties of the proposed version were also investigated in a sample of Korean older adults. DESIGN: This study employed methodological research design. SETTINGS AND PARTICIPANTS: A sample of 31 older adults was recruited through local senior citizen centers to examine the construct validity and the test-retest reliability. For the concurrent validity testing, a sample of 85 older adults with chronic pain was recruited through a general hospital and an oriental medical hospital. METHODS: The construct validity was examined by determining if the subjects perceive the FPS as representing pain and they agree on the rank of each face. The test-retest reliability was examined at a 2-week interval. The concurrent validity was examined by using the NRS and the Visual Analogue Scale (VAS). RESULTS: Subjects perceived the 11 FPS as a pain measure, and the subjects' agreements in the rank ordering of the faces were almost perfect (Kendall's W = .93, p < .001). Cohen's kappa of .61 (p < .001) for test-retest reliability was acceptable in the cognitively intact subjects. Concurrent validity measured by the correlation between the FPS and the NRS (r = .73, p < .001) and the VAS (r = .73, p < .001) was supported. CONCLUSIONS: These results supported the appropriateness of the 11 FPS for use with the older adults in clinical practice to measure pain intensity. Additionally, this study provided cross-cultural evidence to evaluate usefulness of the FPS.

Aged↗

The validity of the brief version of the Fear of Negative Evaluation Scale.

The Fear of Negative Evaluation Scale [FNE; J. Consult. Clin. Psychol. 33 (1969) 448] is a commonly used measure of social anxiety. A brief version of the scale (FNEB) is available for convenient administration. Despite being widely advocated for use, the psychometric properties of the FNEB have not been evaluated with clinically anxious samples. The present study addressed the reliability and validity of the FNEB in a clinical sample of individuals with either social phobia (n = 82) or panic disorder (n = 99) presenting for treatment. Factor analysis supported the construct validity of the FNEB. The validity of the FNEB was further demonstrated through significant correlations with social avoidance and depression, and non-significant correlations with agoraphobic avoidance and demographic variables. The scale obtained excellent inter-item reliability (alpha = .97) and 2-week test-retest reliability (r = .94). Discriminant function analysis also supported validity of the FNEB. For example, individuals with social phobia scored significantly higher on the FNEB than those with panic disorder and a group of non-psychiatric community controls (n = 30). The FNEB was sensitive to pre- to post-CBT changes in both social anxiety and panic disorder, and changes on the FNEB correlated significantly with other measures of treatment responsiveness, such as reductions in somatic arousal, depression and other anxiety symptomatology. These research findings strongly support the validity of the FNEB and its clinical utility as an outcome measure in social anxiety treatment.

Adult↗

Self-report INH adherence measures were reliable and valid in Latino adolescents with latent tuberculosis infection.

BACKGROUND AND OBJECTIVE: To test the reliability and validity of 8-day and 30-day self-report measures of adherence to daily isoniazid (INH) for treatment of latent tuberculosis infection (LTBI). METHODS: Participants were 286 Latino adolescents (ages 13-18, 55.6% male) with LTBI recruited from 10 public middle and high schools in San Diego County. INH adherence was measured monthly for up to 9 months by interview and urine specimens at unannounced visits. Reliability and validity analyses were performed within 5 consecutive months. Reliability was assessed by correlating: (1) 8- and 30-day INH adherence measures within each month; and (2) each of the two adherence measures across months. Validity was assessed by correlating reported measures with biological assays within each month. RESULTS: Reliability tests yielded significant correlation coefficients (p < .05 to .001), both across measures (r = 0.71-0.93) and across time (r = 0.29-0.64 for 8-day recall; r = 0.32-0.69 for 30-day recall). Validity tests of both adherence measures were also significant (p < .05 to .001): 8-day recall (r(pb) = 0.52-0.72) and 30-day recall (r(pb) = 0.37-0.71). CONCLUSION: Results suggest that impromptu recall measures of INH adherence, combined with urine collection, are reliable and valid in Latino adolescents.

Adolescent↗

The Soterion Rapid Triage System: evaluation of inter-rater reliability and validity.

The Soterion Rapid Triage System is a new, computerized, five-level triage acuity system. The purpose of this study was to evaluate the system's inter-rater reliability and validity for stratifying patient acuity. The study was comprised of two components. A prospective evaluation of inter-rater reliability was conducted by the blinded, paired simultaneous triage of 423 patients. A retrospective evaluation of validity consisted of the analysis of 33,850 patients triaged with the system over an 8-month period. The system's validity was measured by in-hospital admission rate, Emergency Department (ED) length-of-stay, hospital charges and Current Procedural Terminology (CPT) Codes 99281-99285. Evaluation of inter-rater reliability demonstrated a weighted kappa of 0.87 (95% confidence interval 0.84, 0.91). The in-hospital admission rates for patients triaged as Level 1 Immediate-Level 5 Non-Urgent were 43%, 30%, 13%, 3% and 1%, respectively (p < 0.0001). Similarly, there were significant differences in the means for all hospital charges, ED lengths-of-stay, and CPT Codes. In conclusion, the Soterion Rapid Triage System possesses high inter-rater reliability and validity. The system's reliability and validity, and the availability of the system's electronically archived data are characteristics beneficial to the development of a national standardized five-level triage acuity system.

Algorithms↗