How Scoring Approaches Impact Estimates of Growth in the Presence of Survey Item Ceiling Effects.

Survey scores are often the basis for understanding how individuals grow psychologically and socio-emotionally. A known problem with many surveys is that the items are all "easy"-that is, individuals tend to use only the top one or two response categories on the Likert scale. Such an issue could be especially problematic, and lead to ceiling effects, when the same survey is administered repeatedly over time. In this study, we conduct simulation and empirical studies to (a) quantify the impact of these ceiling effects on growth estimates when using typical scoring approaches like sum scores and unidimensional item response theory (IRT) models and (b) examine whether approaches to survey design and scoring, including employing various longitudinal multidimensional IRT (MIRT) models, can mitigate any bias in growth estimates. We show that bias is substantial when using typical scoring approaches and that, while lengthening the survey helps somewhat, using a longitudinal MIRT model with plausible values scoring all but alleviates the issue. Results have implications for scoring surveys in growth studies going forward, as well as understanding how Likert item ceiling effects may be contributing to replication failures.

Leptospirosis in the Air: A Case Review Series During Air Medical Transport in Haiti.

Leptospirosis is an infectious illness encountered mostly in tropical climates and has been of particular concern in Haiti after natural disasters. Heavy rainfalls and natural disasters in combination with scarce resources to control and identify clusters of infections make certain populations and countries vulnerable. In some cases, patients who contract this disease may need air medical transport to hospitals that have a higher level of care. In this case report, a trio of cases is highlighted from an outbreak that required air transport to transfer patients to a facility with the availability of an intensive care unit. The goal of highlighting these cases is to increase the awareness of physicians and air transport providers to the manifestation and treatment of this disease and to provide pearls to stabilize patients during transport.

Comparison of clinical and radiographic outcomes of arthroscopic-assisted percutaneous fixation versus open reduction internal fixation of lateral tibial plateau fractures.

PURPOSE: Treatment for tibial plateau fractures continues to evolve but maintains primary objectives of anatomic reduction of the joint line and a rapid recovery course. Arthroscopic-assisted percutaneous fixation (AAPF) has been introduced as an alternative to traditional open reduction internal fixation (ORIF). The purpose of the study is to compare clinical and radiographic outcomes in patients with low-energy Schatzker type I-III tibial plateau fractures treated with AAPF versus ORIF. METHODS: A retrospective chart review was performed at a level 1 trauma centre to compare outcomes of 120 patients (57 AAPF, 63 ORIF) with low-energy lateral Schatzker type I-III tibial plateau fractures who underwent tibial plateau fixation between 2009 and 2018. Demographic information, injury characteristics, and surgical treatment were recorded. The main outcome measurements included reduction step-off, joint space narrowing, time to weight bearing, and implant removal. RESULTS: There was no difference in age, gender distribution, BMI, ASA, Schatzker classification distribution, initial displacement, blood loss, and reduction step-off between the two groups (p > 0.05). Shorter tourniquet time (74.1 ± 21.7 vs 100.0 ± 21.0 min; p < 0.001), shorter time to full weight bearing (47.8 ± 15.2 vs. 69.1 ± 17.2 days; p < 0.001), and lower rate of joint space narrowing (3.5% vs. 28.6% with more than 1 mm, p < 0.001) were associated with the AAPF cohort, with no difference in pain, knee range of motion, or implant removal rate between the two cohorts. CONCLUSION: AAPF may be a viable alternative to ORIF for the management of low-energy tibial plateau fractures with outcomes not inferior compared to the traditional ORIF method.

Examining heterogeneity in mentoring: Associations between mentoring discussion topics and youth outcomes.

The current study aims to apply a staged approach to document heterogeneity in discussions in mentoring relationships, chiefly, discussion topics from weekly mentoring sessions with undergraduate women mentors (n = 40), then link each of the eight topics (relationships with friends, family, teachers, and romantic relationships, as well as goals, academic skills, academic problems, and hopes for the future) to developmental outcomes for middle school girls (n = 41) who participated in a school-based mentoring program. In doing so, the authors hope to better understand the mechanisms that influence variability in mentoring treatment effects. Mentoring dyads engaged in unstructured one-on-one sessions and structured group meetings across the 2018-2019 academic year. The primary predictors for this study are weekly mentor-reported discussion topics and activities addressed during unstructured one-on-one mentoring sessions, with 11 social-emotional, academic, and behavioral outcomes measured via pre- and postsurveys administered by research assistants to mentees during the fall and spring. A series of 11 path analyses indicate small to moderate associations, both beneficial and negative, between key discussion topics, such as hopes for the future, family relationships, and goals, and several mentee-reported outcomes of interest at the end of the intervention, including extrinsic motivation, life satisfaction, and self-esteem. Study findings provide information about heterogeneity in mentoring practices to inform how various mechanisms of mentoring (e.g., discussions focused on relationships, goals and skills, and strengths) influence developmentally-relevant effects for youth.

Complications in the 2-Year Postoperative Period Following Pediatric Syndactyly Release.

PURPOSE: Syndactyly surgical release is one of the most common congenital hand surgeries performed by pediatric hand surgeons. The purpose of our study was to evaluate the complications associated with syndactyly release and determine factors that correlate with higher complication rates within the 2-year postoperative period. METHODS: A retrospective chart review was completed for patients who underwent syndactyly release at a single pediatric center between 2005 and 2018. Patients were included if they had a diagnosis of syndactyly and underwent surgical release, and excluded for a diagnosis of cleft hand, incomplete surgical documentation, surgery performed at an outside institution, or follow-up care that did not extend beyond the first postoperative visit. Complications were classified using the Clavien-Dindo (CD) system. RESULTS: Fifty-nine patients met the inclusion criteria, which included 143 webs released in 85 surgeries. A total of 27 complications occurred for the 85 surgeries performed. The severity of complications was CD grade I or II in 23% of surgeries, most commonly unplanned cast changes, and CD grade III in 8% of surgeries. No CD grade IV or V complications occurred. The CD grade III complications included 6 reoperations. The complication rate was higher when performing >1 syndactyly release per surgery. It also was higher for patients undergoing >1 surgical event. Rates of complication per surgery were similar between patients with multiple surgeries compared with those with a single surgery. Concomitant diagnoses and complexity of syndactyly was not associated with a higher complication rate. CONCLUSIONS: Syndactyly release was associated with a complication rate of 31% per surgical event with 44% of these complications related to unplanned cast changes and 8% of complications that required admission or reoperation. Risk factors for complications following syndactyly release include >1web operated on per surgery and undergoing >1 surgical event. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognosis IV.

How survey scoring decisions can influence your study's results: A trip through the IRT looking glass.

Though much effort is often put into designing psychological studies, the measurement model and scoring approach employed are often an afterthought, especially when short survey scales are used (Flake & Fried, 2020). One possible reason that measurement gets downplayed is that there is generally little understanding of how calibration/scoring approaches could impact common estimands of interest, including treatment effect estimates, beyond random noise due to measurement error. Another possible reason is that the process of scoring is complicated, involving selecting a suitable measurement model, calibrating its parameters, then deciding how to generate a score, all steps that occur before the score is even used to examine the desired psychological phenomenon. In this study, we provide three motivating examples where surveys are used to understand individuals' underlying social emotional and/or personality constructs to demonstrate the potential consequences of measurement/scoring decisions. These examples also mean we can walk through the different measurement decision stages and, hopefully, begin to demystify them. As we show in our analyses, the decisions researchers make about how to calibrate and score the survey used has consequences that are often overlooked, with likely implications both for conclusions drawn from individual psychological studies and replications of studies. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Strategies for monitoring mentoring relationship quality to predict early program dropout.

We examined data from a nationally implemented mentoring program over a 4-year period, to identify demographic and relationship characteristics associated with premature termination. Data were drawn from a sample of 82,224 mentor and mentees. We found matches who reported shared racial or ethnic identities were associated with lower likelihood of premature termination as was mentee's positive feelings of the relationship. We also found that, if data were used as a screening tool, the data were suboptimal for accuracy classifying premature closure with sensitivity and specificity values equal to 0.43 and 0.75. As programs and policymakers consider ways to improve the impact of mentoring programs, these results suggest programs consider the types of data being collected to improve impact of care.

Promoting mentoring relationships through joint decisions: Evidence from a national mentoring program.

School-based mentoring programs are one of the most popular types of prevention programs offered to support students' social-emotional and academic success. Because a high-quality mentoring relationship is thought to be a mechanism for improving youth outcomes, we investigated how mentor- and mentee-relationship quality develops over time. In addition, we examined how relationship development varied as a function of three approaches to selecting mentoring activities (i.e., mentor-directed, program-directed, or jointly determined). We used a random-intercepts crossed-lagged panel model to test how mentor and mentee reports of relationship quality developed over three time points across one school year. Data were gathered from 2014 to 2018 and included 47,699 youth (56% female; 51% Black or Hispanic) who participated in Big Brothers Big Sisters-which provides school-based mentoring services to youth across the U.S. Results indicated that mentors' positive appraisals of the mentoring relationships led to positive appraisals from the mentee at the subsequent time point. In addition, when mentors and mentees jointly determined activities, we found evidence that mentors' and mentees' positive appraisals at one time point led to positive appraisals at the following time point. These results suggest that school-based mentoring programs should consider ways to support joint decision-making among mentors and mentees participating in school-based mentoring programs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Promoting social emotional development during the paediatric well-child visit: a demonstration project.

Supporting social emotional development, beginning at birth, can improve lifelong health. The American Academy of Paediatrics recommends 12 well-child visits between birth and age 3 years. Each well-child visit provides a unique opportunity to interact with and support families to promote social emotional development of children. Eighteen US paediatric practices joined a learning community to use improvement science to test and implement evidence-informed strategies that nurture parent-child relationships and promote the social emotional development of young children.Quality improvement methods were used to integrate 11 strategies into well-child visits between birth and age 3 years and measure the improvements with a set of outcome, process and balancing measures. Participation among the 18 paediatric practices was high with 72% of teams attending monthly webinars and 97% of teams attending the three learning sessions. Over 12 months, the percentage of children receiving age-appropriate social emotional development screens at participating practices' well-child visits increased from a baseline median of 83% to 93%.Current paediatric practice in the USA focuses primarily on cognitive and physical development, and paediatric providers are less familiar with established practices to screen for social emotional development and promote the caregiver-child relationship. This project suggests that improvement methods show promise in increasing the number of children who receive age-appropriate social emotional development screens or assessments at well-child visits.

Improving the school environment: School staff perceptions of school climate data and reporting practices.

School climate surveys have become widely used in U.S. schools, but there is little information on whether school leaders engage teachers and other staff in the process of reviewing and making use of survey results. This mixed-methods study examined staff interest, viewing, and use of survey results in a state that administers a school climate survey. Semistructured interviews with 15 staff members were conducted to gain insight into quantitative results from 16,525 staff members in 318 high schools. Survey data showed that although 84% of school staff were interested in seeing the results of their school climate survey, fewer than one-third reported seeing the results or using them for school planning or improvement. Administrators were more likely than teachers and other staff to have seen and used survey results. Content coding of the qualitative data elaborated on staff interest in reviewing and using climate data. These findings highlight the need for school leaders to collaborate with school staff on interpreting and using survey results for school climate improvement efforts.

Systematic identification and referral of smokers attending HIV ambulatory care highlights the failure of current service provision in an at-risk population.

Introduction: People living with HIV (PLWH) are more likely to smoke than the general population and are at greater risk of smoking-related illness. Healthcare services need to address this burden of preventable disease. Methods: We evaluated the impact of a brief intervention that asked service users about smoking when they attended for ambulatory HIV care in London, UK, and offered referral to smoking cessation. Results: Overall, 1548 HIV-positive individuals were asked about their smoking status over a 12-month period. Of this group, 385 (25%) reported that they were current smokers, 372 (97%) were offered referral to smoking cessation services and 154 (40%) accepted this. We established an outcome of referral for 114 (74%) individuals. A total of 36 (10% of smokers) attended stop smoking clinics and 16 (4%) individuals were recorded as having quit smoking. Discussion: The simple intervention of asking PLWH about tobacco smoking and offering referral to smoking cessation services rapidly identified current smokers, 40% of whom accepted referral to smoking cessation services. This highlights the importance of promoting behaviour and lifestyle changes with every contact with health services. However, a large proportion of those referred were either not seen in local services or the outcome of referral could not be ascertained. If the risk of smoking-related morbidity among PLWH is to be reduced, more sustainable referral pathways and ways of improving uptake of smoking cessation services must be developed.

Peer mentoring for eating disorders: results from the evaluation of a pilot program.

BACKGROUND: Eating disorders (EDs) are serious psychiatric illnesses that have high rates of morbidity and mortality, and low long-term recovery rates. Peer mentor programs (PMPs) have been associated with reduced psychiatric hospitalisation and shorter lengths of stay for those with other severe mental illnesses. The present study evaluated the feasibility and preliminary efficacy of a PMP for individuals with EDs in improving symptomatology and quality of life. METHODS: Thirty mentees and seventeen mentors were recruited. The PMP involved thirteen sessions over 6 months. Participants completed measures assessing ED symptomatology, quality of life (QoL), mood and perceived disability. Changes in symptomatology before and after the PMP were tested by Wilcoxon signed rank tests. Semi-structured interviews were conducted for qualitative evaluation of the PMP. RESULTS: The program was deemed to have moderate feasibility with eight of 30 mentees, and two of 17 mentors withdrawing. Completion rates ranged from 2 to 16 sessions, and between 3 and 45 weeks. Mentees demonstrated improvements in body mass index, QoL, ED symptomatology, mood (depression, anxiety and tension/stress) and perceived disability from pre- to post-program. Mentors demonstrated significant increases in ED symptomatology, but no worsening of QoL, mood or perceived disability. Qualitative findings from both mentees and mentors were positive: emergent themes included hope for recovery, a sense of agency and inspiration gained from interaction with someone with lived experience of an ED. CONCLUSIONS: This pilot study suggests feasibility of the PMP for individuals with EDs. Mentees demonstrated improvements in ED symptomatology, QoL, mood and perceived disability. However, the increase in ED symptomatology reported by the mentors over the PMP highlights potential risks and the need for thorough monitoring while preliminary evaluation is undertaken. The mentoring relationship was a positive experience for both mentees and mentors, instilling an increased hope for recovery in mentees and an opportunity for mentors to reflect on their own recovery with increased confidence. The novel relationship formed throughout mentorship highlights a potential gap in current clinical support services, which warrants further exploration within a controlled trial. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registration Number: ACTRN12617001412325. Retrospectively registered: 05/10/2017. Date of first enrolment: 20/01/2017. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373741&isReview=true.

Comparison of PC and iPad administrations of the Cogstate Brief Battery in the Mayo Clinic Study of Aging: Assessing cross-modality equivalence of computerized neuropsychological tests.

Objective: Computerized neuropsychological assessments are increasingly used in clinical practice, population studies of cognitive aging and clinical trial enrichment. Subtle, but significant, performance differences have been demonstrated across different modes of test administration and require further investigation. Method: Participants included cognitively unimpaired adults aged 50 and older from the Mayo Clinic Study of Aging who completed the Cogstate Brief Battery and Cogstate's Groton Maze Learning Test (GMLT) on an iPad or a personal computer (PC) in the clinic. Mode of administration differences and test-retest reliability coefficients were examined across 3 cohorts: a demographically matched test-retest cohort completing PC and iPad administrations the same day (N = 168); a test naïve cohort comparing baseline PC (n = 1820) and iPad (n =605) performance; and a demographically matched longitudinal cohort completing 3 Cogstate visits over 15 months on either the PC (n =63) or iPad (n =63). Results: Results showed a small but statistically significant and consistent finding for faster performance on PC relative to iPad for several Cogstate Brief Battery measures. Measures of accuracy generally did not differ or differences were very small. The GMLT showed faster performance and higher total errors on iPad. Most Cogstate variables showed no difference in the rate of change across PC and iPad administrations. Conclusions: There are small, but significant, differences in performance when giving the same cognitive tests on a PC or an iPad. Future studies are needed to better understand if these small differences impact the clinical interpretation of results and research outcomes.

Small Sets of Novel Words Are Fully Retained After 1-Week in Typically Developing Children and Down Syndrome: A Fast Mapping Study.

OBJECTIVES: Down syndrome (DS) is a population with known hippocampal impairment, with studies showing that individuals with DS display difficulties in spatial navigation and remembering arbitrary bindings. Recent research has also demonstrated the importance of the hippocampus for novel word-learning. Based on these data, we aimed to determine whether individuals with DS show deficits in learning new labels and if they may benefit from encoding conditions thought to be less reliant on hippocampal function (i.e., through fast mapping). METHODS: In the current study, we examined immediate, 5-min, and 1-week delayed word-learning across two learning conditions (e.g., explicit encoding vs. fast mapping). These conditions were examined across groups (twenty-six 3- to 5-year-old typically developing children and twenty-six 11- to 28-year-old individuals with DS with comparable verbal and nonverbal scores on the Kaufman Brief Intelligence Test - second edition) and in reference to sleep quality. RESULTS: Both individuals with and without DS showed retention after a 1-week delay, and the current study found no benefit of the fast mapping condition in either group contrary to our expectations. Eye tracking data showed that preferential eye movements to target words were not present immediately but emerged after 1-week in both groups. Furthermore, sleep measures collected via actigraphy did not relate to retention in either group. CONCLUSIONS: This study presents novel data on long-term knowledge retention in reference to sleep patterns in DS and adds to a body of knowledge helping us to understand the processes of word-learning in typical and atypically developing populations. (JINS, 2018, 24, 955-965).

Subjective cognitive decline and risk of MCI: The Mayo Clinic Study of Aging.

OBJECTIVE: We investigated different dimensions of subjective cognitive decline (SCD) to determine which was the best prognostic risk factor for incident mild cognitive impairment (MCI) among cognitively unimpaired participants. METHODS: We included 1,167 cognitively unimpaired participants, aged 70 to 95 years, from the Mayo Clinic Study of Aging based on 2 concurrent SCD scales (part of the Blessed memory test and the 39-item Everyday Cognition [ECog] scale, which included a validated 12-item derivative) and a single question assessing worry about cognitive decline. We evaluated multiple ways to dichotomize scores. In continuous models, we compared average scores on 4 ECog domains and multidomain (39- and 12-item) ECog scores. Cox proportional hazards models were used to assess the association between each measure and risk of MCI in models adjusted for objective memory performance, depression, anxiety, sex, APOE ε4 carriership, and medical comorbidities. RESULTS: It was possible to select a substantial group of participants (14%) at increased risk of incident MCI based on combined baseline endorsement of any consistent SCD on the ECog (any item scored ≥3; 12-item ECog hazard ratio [HR] 2.17 [95% confidence interval 1.51-3.13]) and worry (HR 1.79 [1.24-2.58]) in an adjusted model combining these dimensions. In continuous models, all ECog domains and the multidomain scores were associated with risk of MCI with a small advantage for multidomain SCD (12-item ECog HR 2.13 [1.36-3.35] per point increase in average score). Information provided by the informant performed comparable to self-perceived SCD. CONCLUSION: Prognostic value of SCD for incident MCI improves when both consistency of SCD and associated worry are evaluated.

Association of antidiabetic medication use, cognitive decline, and risk of cognitive impairment in older people with type 2 diabetes: Results from the population-based Mayo Clinic Study of Aging.

OBJECTIVE: To determine the cross-sectional and longitudinal associations between diabetes treatment type and cognitive outcomes among type II diabetics. METHODS: We examined the association between metformin use, as compared to other diabetic treatment (ie, insulin, other oral medications, and diet/exercise) and cognitive test performance and mild cognitive impairment (MCI) diagnosis among 508 cognitively unimpaired at baseline type II diabetics enrolled in the Mayo Clinic Study of Aging. We created propensity scores to adjust for treatment effects. We used multivariate linear and logistic regression models to investigate the cross-sectional association between treatment type and cognitive test z scores, respectively. Mixed effects models and competing risk regression models were used to determine the longitudinal association between treatment type and change in cognitive test z scores and risk of developing incident MCI. RESULTS: In linear regression analyses adjusted for age, sex, education, body mass index, APOE ε4, insulin treatment, medical comorbidities, number of medications, duration of diabetes, and propensity score, we did not observe an association between metformin use and cognitive test performance. Additionally, we did not observe an association between metformin use and cognitive test performance over time (median = 3.7-year follow-up). Metformin was associated with an increased risk of MCI (subhazard ratio (SHR) = 2.75; 95% CI = 1.64, 4.63, P < .001). Similarly, other oral medications (SHR = 1.96; 95% CI = 1.19, 3.25; P = .009) and insulin (SHR = 3.17; 95% CI = 1.27, 7.92; P = .014) use were also associated with risk of MCI diagnosis. CONCLUSIONS: These findings suggest that metformin use, as compared to management of diabetes with other treatments, is not associated with cognitive test performance. However, metformin was associated with incident MCI diagnosis.

Peer mentoring for eating disorders: evaluation of a pilot program.

BACKGROUND: Eating disorders are serious psychiatric illnesses that are often associated with poor quality of life and low long-term recovery rates. Peer mentor programs have been found to improve psychiatric symptoms and quality of life in other mental illnesses, and a small number of studies have suggested that eating disorder patients may benefit from such programs. The aim of this study is to assess the efficacy of a peer mentor program for individuals with eating disorders in terms of improving symptomatology and quality of life. METHODS: Up to 30 individuals with a past history of an eating disorder will be recruited to mentor 30 individuals with a current eating disorder. Mentoring will involve 13 sessions (held approximately every 2 weeks), of up to 3 h each, over 6 months. DISCUSSION: This pilot proof-of-concept feasibility study will inform the efficacy of a peer mentoring program on improving eating disorder symptomatology and quality of life, and will inform future randomised controlled trials. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registration Number: ACTRN12617001412325. The date of registration (retrospective): 05/10/2017.

Bidirectional Text Messaging to Improve Adherence to Recommended Lipid Testing.

BACKGROUND: Synergies between technology and health care in the United States are accelerating, increasing opportunities to leverage these technologies to improve patient care. METHODS: This study was a collaboration between an academic study team, a rural primary care clinic, and a local nonprofit informatics company developing tools to improve patient care through population management. Our team created a text messaging management tool, then developed methods for and tested the feasibility of bidirectional text messaging to remind eligible patients about the need for lipid testing. We measured patient response to the text messages, then interviewed 8 patients to explore their text messaging experience. RESULTS: Of the 129 patients the clinic was able to contact by phone, 29.4% had no cell phone or text-messaging capabilities. An additional 20% refused to participate. Two thirds of the 28 patients who participated in the text messaging intervention (67.9%) responded to at least 1 of the up to 3 messages. Seven of 8 interviewed patients had a positive text-messaging experience. CONCLUSIONS: Bidirectional text messaging is a feasible and largely acceptable form of communication for test reminders that has the potential to reach large numbers of patients in clinical care.