The development of an HIV-specific complexity rating scale

As treatment for HIV improves, an ageing population is experiencing comorbidity which often leads to complex clinical presentations requiring an interdisciplinary care approach. This study sought to quantify clinician assessment of the level of clinical complexity, through the development of a rating scale for people living with HIV (PLHIV), to improve client care through an interdisciplinary care model. An existing alcohol and other drug complexity rating scale was selected and modified for use with PLHIV. HIV-specific items were included through consultation with an interdisciplinary team. A risk-prediction model was developed and validated using clinician ratings of clients attending The Albion Centre, a tertiary HIV clinic in Sydney, Australia, resulting in the development of the Clinical Complexity Rating Scale for HIV (CCRS-HIV). Multivariable logistic regression models identified eight characteristics based on clinician assessment of complexity in PLHIV: financial instability, social isolation, problematic crystal methamphetamine use, mental illness and/or other problematic substance use, cognitive/neurological impairment, polypharmacy, current hepatitis C infection and/or cancer, and other physical health comorbidity. A weighted risk-prediction model was developed and validated. The final model accurately predicted 85% of complex clients, with a sensitivity of 80% and specificity of 91%. This study developed an HIV-specific clinician-rated complexity scale. Further investigations are required to validate the CCRS-HIV with broader HIV populations. This simple complexity screening tool is a promising adjunct to clinical assessment to identify clients with complex physical and psychosocial needs who may benefit from interdisciplinary care interventions and allocation of resources.

Complex Acoustic Environments: Review, Framework, and Subjective Model

The concept of complex acoustic environments has appeared in several unrelated research areas within acoustics in different variations. Based on a review of the usage and evolution of this concept in the literature, a relevant framework was developed, which includes nine broad characteristics that are thought to drive the complexity of acoustic scenes. The framework was then used to study the most relevant characteristics for stimuli of realistic, everyday, acoustic scenes: multiple sources, source diversity, reverberation, and the listener’s task. The effect of these characteristics on perceived scene complexity was then evaluated in an exploratory study that reproduced the same stimuli with a three-dimensional loudspeaker array inside an anechoic chamber. Sixty-five subjects listened to the scenes and for each one had to rate 29 attributes, including complexity, both with and without target speech in the scenes. The data were analyzed using three-way principal component analysis with a (2 3 2) Tucker3 model in the dimensions of scales (or ratings), scenes, and subjects, explaining 42% of variation in the data. “Comfort” and “variability” were the dominant scale components, which span the perceived complexity. Interaction effects were observed, including the additional task of attending to target speech that shifted the complexity rating closer to the comfort scale. Also, speech contained in the background scenes introduced a second subject component, which suggests that some subjects are more distracted than others by background speech when listening to target speech. The results are interpreted in light of the proposed framework.

Ontario Protocol Assessment Level: Clinical Trial Complexity Rating Tool for Workload Planning in Oncology Clinical Trials

The Ontario Protocol Assessment Level (OPAL) protocol complexity rating scale provides a method of quantifying clinical trial activity on the basis of study protocol complexity and the resulting increase in workload. With consistent application of OPAL, sites can manage staffing objectively.