Trend Analysis of Aggregate Outcomes in Complex Health Survey Data.

Public health and clinical practice pattern trends are often analyzed using complex survey data. Use of statistical approaches that do not account for survey design predisposes to error, potentially leading to resource misdirection and inefficiency. This study examined two techniques for analyzing trends in complex survey data: (1) design-corrected logistic regression and (2) jackknife re-weighted linear regression. These approaches were compared toweighted least squares regression, as well as non-design corrected techniques. Data were obtained from NEISS, a complex survey of emergency departments that can be weighted to produce national estimates of injury occurrence. Trends were analyzed in rug-related injuries among male versus female patients ≥65 years of age. All design-corrected techniques performed comparably in assessment of trend within sex-based subgroups. In almost all cases, design-corrected approaches contrasted profoundly with standard statistical techniques. Future analyses may employ these design-corrected approaches to appropriately account for estimate variance in complex survey data.

Using Demographic Factors and Comorbidities to Develop a Predictive Model for ICU Mortality in Patients with Acute Exacerbation COPD.

Recognizing factors associated with mortality in patients admitted to the ICU with acute exacerbation of chronic obstructive pulmonary disease could reduce healthcare costs and improve end-of-life care. Previous studies have identified possible predictive variables, but analysis is lacking on the combined effect of demographic factors and comorbidities. Using the MIMIC-III database, this study examined factors associated with mortality in a model incorporating comorbidities, comorbidity indices, and demographic factors. After determining associations between predictive variables and mortality through univariate and multivariate binomial logistic regression, three predictive models were developed: (1) univariate GLM-derived logistic, (2) Mean Gini-derived logistic (MGDL), and (3) random forest. The MGDL model best predicted mortality with an AUROC of 0.778. Variables with the greatest relative importance in determining mortality included the Charlson Comorbidity Index, Elixhauser Index, male, and arrhythmia. The results support the potential of using the MGDL model and need for further work in exploring demographic factors.

An Automated System for Categorizing Transthoracic Echocardiography Indications According to the Echocardiography Appropriate Use Criteria.

The Echocardiography Appropriate Use Criteria (EAUC) are a set of indications for transthoracic echocardiography (TTE) developed to guide physician decision making around ordering of TTE. In this study, an automated rule-based method for processing "indications" listed within TTE reports and classification into one of the major EAUC categories was developed and validated against a clinician-annotated reference standard. The system performed at a comparable level to trained physicians allowing for the automated classification of more than 30,000 TTE indications from a public database in less than ten minutes. The most common indication for TTE was Valvular assessment closely followed by General. Hypertension/Heart Failure/Cardiomyopathy, Acute, and Cardiac Structure assessment each contributed more than ten percent within this patient population. These results suggest potential for automated approaches for tracking appropriate use of TTE, as well as guide the development of systems for prospectively identifying when TTE use is recommended.

Autobiographical memory specificity among preschool-aged children.

Overgeneral memory refers to difficulty retrieving specific autobiographical memories and is consistently associated with depression and/or trauma. The present study developed a downward extension of the Autobiographical Memory Test (AMT; Williams & Broadbent, 1986) given the need to document normative developmental changes in ability to retrieve specific memories among preschoolers. Confirmatory factor analysis and item response theory demonstrated that the AMT-Preschool Version maintained the same underlying 1-factor structure as the original. Additionally, the present study determined that child age was associated with increased specificity. Inhibitory control was evaluated as a potential mediator. Although age was related to inhibition, inhibition was unrelated to memory specificity. This finding adds to research suggesting that behavioral inhibition is unrelated to overgeneral memory among youth.

Knowing where to draw the line: perceptual differences between risk-takers and non-risk-takers.

There are a variety of reasons someone might engage in risky behaviors, such as perceived invulnerability to harm or a belief that negative outcomes are more likely for others than for oneself. However, these risk-taking biases are often measured at a decision-making level or from the developmental perspective. Here we assessed whether or not risk-taking influenced perceptual judgments associated with risk. Participants were provided an objective task to measure individual differences in the perception of physical dimensions (i.e., actual size of a balloon) versus the perception of risk (i.e., size at which the balloon would explode). Our results show that specific differences in risk-taking personalities produce specific differences in perceptual judgments about risk, but do not affect perception of the actual dimensions. Thus, risk-takers differ from non-risk-takers in the perceptual estimations they make about risks, and therefore may be more likely to engage in dangerous or uncertain behaviors because they perceive risks differently.

Factor structure and psychometric properties of a brief measure of dysfunctional individuation.

Individuation is widely considered a fundamental developmental task of adolescence. It is a process through which the adolescent seeks to define new boundaries between his or her self and others, and the failure to do so has been shown to have serious consequences. Given its importance for understanding developmental transitions, it is surprising that there are few assessments of dysfunctional individuation. Over three studies, we provide evidence of a promising new measure of this important construct: the 10-item Dysfunctional Individuation Scale (DIS). Using confirmatory factor analysis and item response theory, we demonstrate that the DIS possesses a strong one-factor structure and excellent psychometric properties. Furthermore, we document the convergent, discriminant, and concurrent validity of the DIS through its relationships with indices of individuation, adjustment, and clinically relevant symptoms. Finally, we examine the incremental validity of the DIS over neuroticism as a predictor of depression (Beck Depression Inventory-II).