Impact of the HIV Tat C30C31S dicysteine substitution on neuropsychological function in patients with clade C disease.

Previous animal studies have identified a C31S residue substitution in the C30C31 dicysteine motif of the Tat protein that is associated with reduced neurovirulence in clade C human immunodeficiency virus (HIV). However, clinical studies of patients infected with clade C HIV have reported significant levels of cognitive impairment. To date, no study has specifically examined cognitive function in clade C-infected patients as a function of the presence or absence of the Tat C31 substitution. The present study investigated the impact of the Tat C30C31S genetic substitution among individuals residing in South Africa infected with clade C HIV that either exhibited the C30C31 motif (n = 128) or the C31S motif (n = 46). A control group of seronegative individuals was included to examine the overall impact of HIV on cognitive performance. All individuals completed a comprehensive neuropsychological battery consisting of tests sensitive to HIV. Results revealed that clade C-infected individuals performed significantly worse across cognitive tests compared to seronegative controls. However, there were no significant differences in cognitive performances between individuals with the C31S motif versus those without the C31S substitution. Proximal CD4 cell count and plasma viral load were unrelated to cognitive performances for either group. Results confirm that the C31S dicysteine motif substitution of the Tat protein does not appreciably moderate neuropsychological outcomes in clade C. Further, these findings highlight the importance of clinical management of cognitive symptoms among individuals infected with this viral clade worldwide.

Differential item functioning of pathological gambling criteria: an examination of gender, race/ethnicity, and age.

This study tested for the presence of differential item functioning (DIF) in DSM-IV Pathological Gambling Disorder (PGD) criteria based on gender, race/ethnicity and age. Using a nationally representative sample of adults from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), indicating current gambling (n = 10,899), Multiple Indicator-Multiple Cause (MIMIC) models tested for DIF, controlling for income, education, and marital status. Compared to the reference groups (i.e., Male, Caucasian, and ages 25-59 years), women (OR = 0.62; P < .001) and Asian Americans (OR = 0.33; P < .001) were less likely to endorse preoccupation (Criterion 1). Women were more likely to endorse gambling to escape (Criterion 5) (OR = 2.22; P < .001) but young adults (OR = 0.62; P < .05) were less likely to endorse it. African Americans (OR = 2.50; P < .001) and Hispanics were more likely to endorse trying to cut back (Criterion 3) (OR = 2.01; P < .01). African Americans were more likely to endorse the suffering losses (OR = 2.27; P < .01) criterion. Young adults were more likely to endorse chasing losses (Criterion 9) (OR = 1.81; P < .01) while older adults were less likely to endorse this criterion (OR = 0.76; P < .05). Further research is needed to identify factors contributing to DIF, address criteria level bias, and examine differential test functioning.

Community based intervention to optimize osteoporosis management: randomized controlled trial.

BACKGROUND: Osteoporosis-related fractures are a significant public health concern. Interventions that increase detection and treatment of osteoporosis are underutilized. This pragmatic randomised study was done to evaluate the impact of a multifaceted community-based care program aimed at optimizing evidence-based management in patients at risk for osteoporosis and fractures. METHODS: This was a 12-month randomized trial performed in Ontario, Canada. Eligible patients were community-dwelling, aged ≥55 years, and identified to be at risk for osteoporosis-related fractures. Two hundred and one patients were allocated to the intervention group or to usual care. Components of the intervention were directed towards primary care physicians and patients and included facilitated bone mineral density testing, patient education and patient-specific recommendations for osteoporosis treatment. The primary outcome was the implementation of appropriate osteoporosis management. RESULTS: 101 patients were allocated to intervention and 100 to control. Mean age of participants was 71.9 ± 7.2 years and 94% were women. Pharmacological treatment (alendronate, risedronate, or raloxifene) for osteoporosis was increased by 29% compared to usual care (56% [29/52] vs. 27% [16/60]; relative risk [RR] 2.09, 95% confidence interval [CI] 1.29 to 3.40). More individuals in the intervention group were taking calcium (54% [54/101] vs. 20% [20/100]; RR 2.67, 95% CI 1.74 to 4.12) and vitamin D (33% [33/101] vs. 20% [20/100]; RR 1.63, 95% CI 1.01 to 2.65). CONCLUSIONS: A multi-faceted community-based intervention improved management of osteoporosis in high risk patients compared with usual care. TRIAL REGISTRATION: This trial has been registered with clinicaltrials.gov (ID: NCT00465387).

Somatic mutations in the DNA repairome in prostate cancers in African Americans and Caucasians.

Most hereditary tumors show aberrations in DNA repair genes or their regulators. In contrast, only a minority of sporadic tumors show alterations in these genes. As a result, genomic instability is currently considered an enhancer of tumorigenesis rather than an obligatory event in this process. However, tumor heterogeneity presents a significant technical challenge for most cancer genomics studies performed at less than 100× mean resolution depth. To address the importance of genomic instability in prostate carcinogenesis and tumor progression, we performed ultrahigh depth exome sequencing of 124 DNA damage repair/response (repairome) genes in 63 tumors and matched normal tissue samples in African Americans and Caucasians. The average sequence depth was 712-fold for DNA isolated from normal tissue and 368-fold for FFPE tumors. We identified 671 somatic mutations in tumors from African Americans and 762 somatic mutations in tumors in Caucasians. The most frequently mutated DNA repairome genes were EXO1, ATR, POLQ, NEIL3, ERCC6, BRCA2, BRCA1, XPC, JAG1, RPA1, POLE, ATM, and LIG1 in African American men, and POLQ, NEIL3, POLB, BRCA2, EXO1, ERCC6, ATR, RBBP8, BRCA1, ATM, JAG1, XPC, and POLE in Caucasians. We found that 89% of tumors had at least one mutation in nucleotide excision repair pathway genes in African Americans, whereas >40% of tumors had mutations in base excision repair pathway genes in Caucasians. We further identified a marginal increase in mutation rate in tumors in African Americans with increasing age. Tumors in Caucasians did not show a correlation with age, but a progressive increase in the mutation rate was observed at higher Gleason scores. Our data reveal significant differences in the molecular signatures in the DNA repairome in prostate cancer between African Americans and Caucasians. These data also have substantial implications regarding the well-known health disparities in prostate cancer, such as the higher mortality in African Americans than Caucasians.

Detection of aberrant responding on a personality scale in a military sample: an application of evaluating person fit with two-level logistic regression.

Person-fit assessment is used to identify persons who respond aberrantly to a test or questionnaire. In this study, S. P. Reise's (2000) method for evaluating person fit using 2-level logistic regression was applied to 13 personality scales of the Schedule for Nonadaptive and Adaptive Personality (SNAP; L. Clark, 1996) that had been administered to military recruits (N = 2,026). Results revealed significant person-fit heterogeneity and indicated that for 5 SNAP scales (Disinhibition, Entitlement, Exhibitionism, Negative Temperament, and Workaholism), the scale was more discriminating for some people than for others. Possible causes of aberrant responding were explored with several covariates. On all 5 scales, severe pathology emerged as a key influence on responses, and there was evidence of differential test functioning with respect to gender, ethnicity, or both. Other potential sources of aberrancy were carelessness, haphazard responding, or uncooperativeness. Social desirability was not as influential as expected.

Model stability of the 15-item Geriatric Depression Scale across cognitive impairment and severe depression.

The 15-item Geriatric Depression Scale (GDS) is used in a wide variety of clinical and research settings. The study's purpose was to further establish the validity of the 15-item GDS by exploring the underlying factor structure in a healthy, nondemented sample of older adults and then analyzing whether this factor structure remained stable across a sample of demented individuals and a sample of individuals with a history of depression 6 months after discharge from an inpatient psychiatric setting. A 2-factor model fit the data best in the exploratory analyses. The 2 factors, Life Satisfaction and General Depressive Affect, found in the nondemented sample (r = .39) remained stable across cognitive impairment (r = .12) but merged into a 1-factor model in the psychiatric sample (r = .93). The results indicate that nondepressed older adults with poor life satisfaction may be identified as depressed on screening instruments such as the 15-item GDS.

An item response theory analysis of DSM-IV personality disorder criteria across younger and older age groups.

Many of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV; American Psychiatric Association, 1994) personality disorder (PD) diagnostic criteria focus on a younger social and occupational context. The absence of age-appropriate criteria for older adults forces researchers and clinicians to draw conclusions based on existing criteria, which are likely inadequate. To explore which DSM-IV PD criteria contain age group measurement bias, the authors report 2 analyses of data on nearly 37,000 participants, ages 18-98 years, taken from a public data set that includes 7 of the 10 PDs (antisocial, avoidant, dependent, histrionic, obsessive-compulsive, paranoid, and schizoid). The 1st analysis revealed that older age groups tend to endorse fewer PD criteria than younger age groups. The 2nd analysis revealed that 29% of the criteria contain measurement bias. Although the latent variable structure for each PD was quite similar across younger and older age groups, some individual criteria were differentially endorsed by younger and older adults with equivalent PD pathology. The presence of measurement bias for these criteria raises questions concerning the assessment of PDs in older adults and the interpretation of existing data.

Confidence intervals for gamma-family measures of ordinal association.

This research focused on confidence intervals (CIs) for 10 measures of monotonic association between ordinal variables. Standard errors (SEs) were also reviewed because more than 1 formula was available per index. For 5 indices, an element of the formula used to compute an SE is given that is apparently new. CIs computed with different SEs were compared in simulations with small samples (N = 25, 50, 75, or 100) for variables with 4 or 5 categories. With N > 25, many CIs performed well. Performance was best for consistent CIs due to N. Cliff and colleagues (N. Cliff, 1996; N. Cliff & V. Charlin, 1991; J. D. Long & N. Cliff, 1997). CIs for Spearman's rank correlation were also examined: Parameter coverage was erratic and sometimes egregiously underestimated.

The reverse of social anxiety is not always the opposite: the reverse-scored items of the social interaction anxiety scale do not belong.

Although well-used and empirically supported, the Social Interaction Anxiety Scale (SIAS) has a questionable factor structure and includes reverse-scored items with questionable utility. Here, using samples of undergraduates and a sample of clients with social anxiety disorder, we extend previous work that opened the question of whether the reverse-scored items belong on the scale. First, we successfully confirmed the factor structure obtained in previous samples. Second, we found the reverse-scored items to show consistently weaker relationships with a variety of comparison measures. Third, we demonstrated that removing the reverse-scored questions generally helps rather than hinders the psychometric performance of the SIAS total score. Fourth, we found that the reverse-scored items show a strong relationship with the normal personality characteristic of extraversion, suggesting that the reverse-scored items may primarily assess extraversion. Given the above results, we suggest investigators consider performing data analyses using only the straightforwardly worded items of the SIAS.

Anchor Selection Using the Wald Test Anchor-All-Test-All Procedure.

Methods for testing differential item functioning (DIF) require that the reference and focal groups are linked on a common scale using group-invariant anchor items. Several anchor-selection strategies have been introduced in an item response theory framework. However, popular strategies often utilize likelihood ratio testing with all-others-as-anchors that requires multiple model fittings. The current study explored alternative anchor-selection strategies based on a modified version of the Wald χ2 test that is implemented in flexMIRT and IRTPRO, and made comparisons with methods based on the popular likelihood ratio test. Accuracies of anchor identification of four different strategies (two testing methods combined with two selection criteria), along with the power and Type I error associated with respective follow-up DIF tests, will be presented. Implications for applied researchers and suggestions for future research will be discussed.

Ramsay-curve item response theory (RC-IRT) to detect and correct for nonnormal latent variables.

Popular methods for fitting unidimensional item response theory (IRT) models to data assume that the latent variable is normally distributed in the population of respondents, but this can be unreasonable for some variables. Ramsay-curve IRT (RC-IRT) was developed to detect and correct for this nonnormality. The primary aims of this article are to introduce RC-IRT less technically than it has been described elsewhere; to evaluate RC-IRT for ordinal data via simulation, including new approaches for model selection; and to illustrate RC-IRT with empirical examples. The empirical examples demonstrate the utility of RC-IRT for real data, and the simulation study indicates that when the latent distribution is skewed, RC-IRT results can be more accurate than those based on the normal model. Along with a plot of candidate curves, the Hannan-Quinn criterion is recommended for model selection.

The factor structure and screening utility of the Social Interaction Anxiety Scale.

The widely used Social Interaction Anxiety Scale (SIAS; R. P. Mattick & J. C. Clarke, 1998) possesses favorable psychometric properties, but questions remain concerning its factor structure and item properties. Analyses included 445 people with social anxiety disorder and 1,689 undergraduates. Simple unifactorial models fit poorly, and models that accounted for differences due to item wording (i.e., reverse scoring) provided superior fit. It was further found that clients and undergraduates approached some items differently, and the SIAS may be somewhat overly conservative in selecting analogue participants from an undergraduate sample. Overall, this study provides support for the excellent properties of the SIAS's straightforwardly worded items, although questions remain regarding its reverse-scored items.

Disgust sensitivity and obsessive-compulsive symptoms in a non-clinical sample.

Disgust sensitivity has been posited to play a role in the etiology and/or maintenance of obsessive-compulsive disorder (OCD); however, results of studies in this area have been mixed. We examined the relationship between specific domains of disgust sensitivity and specific OCD symptom patterns. One thousand and five undergraduate volunteers completed an internet battery of questionnaires including measures of OCD symptoms, depression, anxiety, and disgust sensitivity. Results indicated that even when controlling for depression and anxiety, several OCD symptom groups (checking, ordering, and washing) were associated with disgust sensitivity. Analysis of residuals, in which we controlled for every other OCD and disgust sensitivity domain for each paired comparison, indicated that the clearest relationship was between washing symptoms of OCD and disgust sensitivity toward hygiene-related stimuli. Examination of these items, however, raises questions about whether commonly accepted measures of disgust sensitivity might confound disgust with other forms of aversion. We discuss possible strategies for clarifying the degree to which fear and disgust are involved in OCD symptoms.

Publication bias in research synthesis: sensitivity analysis using a priori weight functions.

Publication bias, sometimes known as the "file-drawer problem" or "funnel-plot asymmetry," is common in empirical research. The authors review the implications of publication bias for quantitative research synthesis (meta-analysis) and describe existing techniques for detecting and correcting it. A new approach is proposed that is suitable for application to meta-analytic data sets that are too small for the application of existing methods. The model estimates parameters relevant to fixed-effects, mixed-effects or random-effects meta-analysis contingent on a hypothetical pattern of bias that is fixed independently of the data. The authors illustrate this approach for sensitivity analysis using 3 data sets adapted from a commonly cited reference work on research synthesis (H. M. Cooper & L. V. Hedges, 1994).

How Item Residual Heterogeneity Affects Tests for Differential Item Functioning.

Differential item functioning (DIF) occurs when people with the same proficiency have different probabilities of giving a certain response to an item. The present study focused on an assumption implicit in popular methods for DIF testing that has received little attention in published literature (item residual homogeneity). The assumption is explained, a strategy for detecting violations of it (i.e., item residual heterogeneity) is illustrated with empirical data, and simulations are carried out to evaluate the performance of binary logistic regression, two-group item response theory (IRT), and the Mantel-Haenszel (MH) test in the presence of item residual heterogeneity. Results indicated that heterogeneity inflated Type I error and attenuated power for logistic regression, and attenuated power and produced biased estimates of the latent focal group mean and standard deviation for two-group IRT. The MH test was robust to item residual heterogeneity, probably because it does not use the logistic function.

Assessing the Straightforwardly-Worded Brief Fear of Negative Evaluation Scale for Differential Item Functioning Across Gender and Ethnicity.

The Brief Fear of Negative Evaluation Scale (BFNE; Leary Personality and Social Psychology Bulletin, 9, 371-375, 1983) assesses fear and worry about receiving negative evaluation from others. Rodebaugh et al. Psychological Assessment, 16, 169-181, (2004) found that the BFNE is composed of a reverse-worded factor (BFNE-R) and straightforwardly-worded factor (BFNE-S). Further, they found the BFNE-S to have better psychometric properties and provide more information than the BFNE-R. Currently there is a lack of research regarding the measurement invariance of the BFNE-S across gender and ethnicity with respect to item thresholds. The present study uses item response theory (IRT) to test the BFNE-S for differential item functioning (DIF) related to gender and ethnicity (White, Asian, and Black). Six data sets consisting of clinical, community, and undergraduate participants were utilized (N=2,109). The factor structure of the BFNE-S was confirmed using categorical confirmatory factor analysis, IRT model assumptions were tested, and the BFNE-S was evaluated for DIF. Item nine demonstrated significant non-uniform DIF between White and Black participants. No other items showed significant uniform or non-uniform DIF across gender or ethnicity. Results suggest the BFNE-S can be used reliably with men and women and Asian and White participants. More research is needed to understand the implications of using the BFNE-S with Black participants.

The Anxiety Sensitivity Index - Revised: psychometric properties and factor structure in two nonclinical samples.

Anxiety sensitivity (AS) is the fear of anxiety-related sensations based on beliefs about their harmful consequences. Despite its status as the most popular measure of AS, the anxiety sensitivity index is too abbreviated to adequately measure the somatic, cognitive, and social facets of the construct. The Anxiety Sensitivity Index - Revised (ASI-R) is a revised and expanded version of the ASI that was developed to improve the assessment of AS and its dimensions. The present study was conducted to examine the psychometric properties and factor structure of the ASI-R. Two large undergraduate samples completed a psychometric assessment package that included the ASI-R and measures of anxiety, depression, and related constructs. Exploratory factor analysis revealed four lower-order ASI-R factors: (1) beliefs about the harmful consequences of somatic sensations; (2) fear of publicly observable anxiety reactions; (3) fear of cognitive dyscontrol; and (4) fear of somatic sensations without explicit consequences. These factors loaded on a single, higher-order factor. Correlations between the ASI-R factors and related variables were consistent with AS theory. Results across both samples in the present study were highly similar. The strengths and limitations of the ASI-R are discussed, and the implications of our findings for the nature and measurement of AS are considered.

More information from fewer questions: the factor structure and item properties of the original and brief fear of negative evaluation scale.

Statistical methods designed for categorical data were used to perform confirmatory factor analyses and item response theory (IRT) analyses of the Fear of Negative Evaluation scale (FNE; D. Watson & R. Friend, 1969) and the Brief FNE (BFNE; M. R. Leary, 1983). Results suggested that a 2-factor model fit the data better for both the FNE and the BFNE, although the evidence was less strong for the FNE. The IRT analyses indicated that although both measures had items with good discrimination, the FNE items discriminated only at lower levels of the underlying construct, whereas the BFNE items discriminated across a wider range. Convergent validity analyses indicated that the straightforwardly-worded items on each scale had significantly stronger relationships with theoretically related measures than did the reverse-worded items. On the basis of all analyses, usage of the straightforwardly-worded BFNE factor is recommended for the assessment of fear of negative evaluation.

The Impact of Sexual Abuse Committed by a Child on Mental Health in Adulthood.

Numerous research studies document the negative mental health outcomes associated with the experience of childhood sexual abuse. In addition, factors such as one's relationship with the perpetrator and the severity of the abuse predict the likelihood of future mental health problems. Less attention, however, has focused on the age of the perpetrator, and recent years have seen an increased interest in children who display sexual behavior problems. College students completed measures of mental health functioning and retrospective reports of maltreatment histories. Participants were categorized as abused by an adult (n = 48), teenager (n = 39), or another child (n = 37), and non-abused (n = 219). Victims of abuse, regardless of perpetrator age, displayed higher levels of mental health problems than non-abused participants. There were no differences between the abused groups on any of the mental health outcomes; however, individuals who were abused by other children were less likely to label their experiences as abuse.

How bandwidth selection algorithms impact exploratory data analysis using kernel density estimation.

Exploratory data analysis (EDA) can reveal important features of underlying distributions, and these features often have an impact on inferences and conclusions drawn from data. Graphical analysis is central to EDA, and graphical representations of distributions often benefit from smoothing. A viable method of estimating and graphing the underlying density in EDA is kernel density estimation (KDE). This article provides an introduction to KDE and examines alternative methods for specifying the smoothing bandwidth in terms of their ability to recover the true density. We also illustrate the comparison and use of KDE methods with 2 empirical examples. Simulations were carried out in which we compared 8 bandwidth selection methods (Sheather-Jones plug-in [SJDP], normal rule of thumb, Silverman's rule of thumb, least squares cross-validation, biased cross-validation, and 3 adaptive kernel estimators) using 5 true density shapes (standard normal, positively skewed, bimodal, skewed bimodal, and standard lognormal) and 9 sample sizes (15, 25, 50, 75, 100, 250, 500, 1,000, 2,000). Results indicate that, overall, SJDP outperformed all methods. However, for smaller sample sizes (25 to 100) either biased cross-validation or Silverman's rule of thumb was recommended, and for larger sample sizes the adaptive kernel estimator with SJDP was recommended. Information is provided about implementing the recommendations in the R computing language.