Background Data from selected centers show that robotic lobectomy (RL) is safe, effective and has comparable 30-day mortality to video assisted lobectomy (VATS). However, widespread adoption of RL is controversial. We used the STS-GTS-Database to evaluate quality metrics for these two minimally invasive lobectomy techniques. Methods A database query for primary clinical stage I or II NSCLC at high volume centers from 2009 to 2013 identified 1,220 RLs and 12,378 VATS. Quality metrics evaluated included operative morbidity, 30-day mortality and nodal upstaging (NU), defined as cN0 to pN1. Multivariable logistic regression was used to evaluate NU. Results RL patients were older, less active, less likely to be an ever smoker, and had higher BMI (all p<0.05). They were also more likely to have coronary heart disease or hypertension (all p<0.001) and to have had preoperative mediastinal staging (p<0.0001). RL operative times were longer (median 186 vs 173 min, p<0.001); all other operative parameters were similar. All postoperative outcomes were similar including complications and 30-day mortality (RL 0.6% vs VATS 0.8%, p=0.4). Median length of stay was 4 days for both, but a higher proportion of RLs stayed < 4 days: 48% vs 39%, p<0.001. NU overall was similar (p=0.6), but with trends favoring VATS in the cT1b group, and RL in the cT2a group. Conclusions RL patients had more co-morbidities and RL operative times were longer, but quality outcome measures including complications, hospital stay, 30-day mortality, and NU suggest RL and VATS are equivalent.

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Elders exposed to either progressive or imaginal relaxation procedures reported significant relaxation effects and showed improvement on measures of personal functioning. The results of the Physical Assessment Scale of the Relaxation Inventory indicated that relaxation responses were acquired within and across sessions. Large, consistent changes in relaxation occurred in all 4 sessions. The Symptom Checklist-90-R, which measures self-reported personal adjustment, showed significant positive changes following relaxation training and at 1-month follow-up. Elders who imagined muscle tension release profited as much as those engaged in actual muscle tension-release activities. This finding is of importance for older adults who may experience physical limitations that contraindicate muscle-tension-release procedures.

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A number of studies have estimated the dependability of domain-referenced mastery tests for a fixed cutoff score. Other studies have estimated the dependability of judgments about the cutoff score. Each of these two types of dependability introduces error. Brennan and Lockwood (1980) analyzed the two kinds of errors together but assumed that the two sources of error were uncorrelated. This paper extends that analysis of the total error in estimates of the difference between the domain score and the cutoff score to allow for covariance between the two types of error.Glaser and Nitko (1971) have defined a criterion-referenced test as one that is designed &dquo;to yield measurements that are directly interpretable in terms of specified performance standards&dquo; (p. 653). A domain-referenced test is given a criterion-referenced interpretation in terms of each person's level of performance on some content domain. For a domain-referenced test, the parameter of interest for each person is the proportion of items in some domain of content that the person could answer correctly. The observed score, the proportion correct on a sample of items from the domain, provides an estimate of the proportion of items in the domain that the examinee could answer correctly. A domain-referenced test that is used to decide whether individuals have attained some particular level of performance is called a mastery test.It is assumed that the domain consists of a large number of discrete tasks or items and that independent random samples can be drawn from the domain. The proportion of items that person p could answer correctly, if exposed to all the items in the domain, is the person's domain score, represented by ~L,. The domain score, I-Lp' is a parameter defined for the person on the domain.Mastery of the domain is defined by establishing a c~t®ff ~~°®~°~, y, on the domain. A person whose domain score, ~,p9 is at or above the cutoff score, ~y9 is said to be a master, and a person whose domain score is below the cutoff score is said to be a nonmaster.Since it is generally not practical to include the entire domain in a test, the domain score is not directly observable. Rather, decisions about mastery are based on the person' performance on a sample of items from the domain. The observed score, X,,, of person p on the Ith of r~ items, in this case a mastery test, is the proportion of items that the person answers correctly on that mastery test. Although !J¡,p is assumed to be a constant for each person, Xp, will typically vary from one sample of items to another.