Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20–60), and full lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov , NCT04384926 . Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include...
This investigation of the comparability of writing assessment prompts was conducted in two phases. In an exploratory Phase I, 47 writing prompts administered in the computer-based Test of English as a Foreign Language™ (TOEFL CBT) from July through December 1998 were examined. Logistic regression procedures were used to estimate prompt difficulty and gender effects. A panel of experts reviewed selected prompts, and a taxonomy of prompt characteristics was developed and related to prompt difficulty and gender differences. In Phase II, 87 prompts administered from July 1998 through March 2000 were analyzed. All of the prompts used in Phase I, together with 40 new prompts, were analyzed using the larger Phase II database.Recommendations are made for statistical quality control procedures to identify less comparable prompts.Key words: computer-based writing assessment, essay prompts, comparability, fairness, polytomous DIF (differential item functioning), gender, logistic regression, proportional odds-The Test of English as a Foreign Language™ (TOEFL ® ) was developed in 1963 by the National Council on the Testing of English as a Foreign Language. The Council was formed through the cooperative effort of more than 30 public and private organizations concerned with testing the English proficiency of nonnative speakers of the language applying for admission to institutions in the United States. In 1965, Educational Testing Service ® (ETS ® ) and the College Board ® assumed joint responsibility for the program. In 1973, a cooperative arrangement for the operation of the program was entered into by ETS, the College Board, and the Graduate Record Examinations (GRE ® ) Board. The membership of the College Board is composed of schools, colleges, school systems, and educational associations; GRE Board members are associated with graduate education.ETS administers the TOEFL program under the general direction of a policy board that was established by, and is affiliated with, the sponsoring organizations. Members of the TOEFL Board (previously the Policy Council) represent the College Board, the GRE Board, and such institutions and agencies as graduate schools of business, junior and community colleges, nonprofit educational exchange agencies, and agencies of the United States government.A continuing program of research related to the TOEFL test is carried out under the direction of the TOEFL Committee of Examiners. Its 12 members include representatives of the TOEFL Board and distinguished English as a second language specialists from the academic community. The Committee meets twice yearly to review and approve proposals for test-related research and to set guidelines for the entire scope of the TOEFL research program. Members of the Committee of Examiners serve four-year terms at the invitation of the Board; the chair of the committee serves on the Board.Because the studies are specific to the TOEFL test and the testing program, most of the actual research is conducted by ETS staff rather than by outside researche...
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