Holistic and mechanical combination in psychological assessment:Why algorithms are underutilized and what is needed to increase their use

Although mechanical combination results in more valid judgments and decisions than holistic combination, existing publications suggest that mechanical combination is rarely used in practice. Yet, these publications are either descriptions of anecdotal experiences or outdated surveys. Therefore, in several Western countries, we conducted two surveys (total N = 323) and two focus groups to investigate (1) how decision makers in psychological and HR practice combine information, (2) why they do (not) use mechanical combination, and (3) what may be needed to increase its use in practice. Many participants reported mostly using holistic combination, usually in teams. The most common reasons for not using mechanical combination were that algorithms are unavailable in practice and that stakeholders do not accept their use. Furthermore, decision makers do not quantify information, do not believe in research findings on evidence-based decision making, and think that combining holistic and mechanical combination results in the best decisions. The most important reason why mechanical combination is used was to increase predictive validity. To stimulate the use of mechanical combination in practice, our results suggest that decision makers should receive more training on evidence-based decision making, and decision aids supporting the use of mechanical combination should be developed

Comparative effectiveness of endovascular versus open repair of ruptured abdominal aortic aneurysm in the Medicare population

ObjectiveEndovascular aortic repair (EVAR) for abdominal aortic aneurysm (AAA) is increasingly used for emergent treatment of ruptured AAA (rAAA). We sought to compare the perioperative and long-term mortality, procedure-related complications, and rates of reintervention of EVAR vs open aortic repair of rAAA in Medicare beneficiaries.MethodsWe examined perioperative and long-term mortality and complications after EVAR or open aortic repair performed for rAAA in all traditional Medicare beneficiaries discharged from a United States hospital from 2001 to 2008. Patients were matched by propensity score on baseline demographics, coexisting conditions, admission source, and hospital volume of rAAA repair. Sensitivity analyses were performed to evaluate the effect of bias that might have resulted from unmeasured confounders.ResultsOf 10,998 patients with repaired rAAA, 1126 underwent EVAR and 9872 underwent open repair. Propensity score matching yielded 1099 patient pairs. The average age was 78 years, and 72.4% were male. Perioperative mortality was 33.8% for EVAR and 47.7% for open repair (P < .001), and this difference persisted for >4 years. At 36 months, EVAR patients had higher rates of AAA-related reinterventions than open repair patients (endovascular reintervention, 10.9% vs 1.5%; P < .001), whereas open patients had more laparotomy-related complications (incisional hernia repair, 1.8% vs 6.2%; P < .001; all surgical complications, 4.4% vs 9.1%; P < .001). Use of EVAR for rAAA increased from 6% of cases in 2001 to 31% in 2008, whereas during the same interval, overall 30-day mortality for admission for rAAA, regardless of treatment, decreased from 55.8% to 50.9%.ConclusionsEVAR for rAAA is associated with lower perioperative and long-term mortality in Medicare beneficiaries. Increasing adoption of EVAR for rAAA is associated with an overall decrease in mortality of patients hospitalized for rAAA during the last decade

Interference control, working memory, concept shifting, and verbal fluency in adults with attention-deficit/hyperactivity disorder (ADHD)

In this study, the authors aimed to examine 4 domains of executive functioning in adults with attention-deficit/hyperactivity disorder (ADHD)-namely interference control, concept shifting, verbal fluency, and verbal working memory. Four groups of participants were included: (a) adults diagnosed with ADHD (ADHD(-): n = 20), (b) adults diagnosed with both ADHD and 1 or more comorbid disorder(s) (ADHD(+): n = 22), (c) adults referred for ADHD because of ADHD symptomatology but not diagnosed as such (non-ADHD; n = 34), and (d) healthy controls (n = 136). ADHD-related deficits (independent of comorbidity) were revealed for concept shifting and verbal working memory. In addition. the ADHD(+) and non-ADHD groups displayed deficits in terms of general processing speed. Given that these deficits were not found in the ADHD(-) group, the authors contend that these deficits are likely attributable to comorbidity rather than ADHD itself. Contrary to the authors' expectations, these findings do not correspond with the cognitive subtype hypothesis

A guided, internet-based stress management intervention for university students with high levels of stress:Feasibility and acceptability study

BackgroundTransitioning to adulthood and challenges in university life can result in increased stress levels among university students. Chronic and severe stress is associated with deleterious psychological and physiological effects. Digital interventions could succeed in approaching and helping university students who might be at risk; however, the experiences of students with internet-based stress management interventions are insufficiently understood.ObjectiveThis study aims to explore the feasibility; acceptability; and changes in perceived stress, depressive symptoms, and quality of life from baseline to posttest assessment of a 5-session, internet-based stress management intervention guided by an e-coach, developed for university students experiencing high levels of stress.MethodsA single-arm study was conducted. Students were recruited from different channels, mainly from a web survey. Students were eligible if they (1) scored ≥20 on the Perceived Stress Scale-10, (2) were aged ≥18 years, and (3) were studying at one of the participating universities. Feasibility and acceptability of the intervention were investigated using several indications, including satisfaction (Client Satisfaction Questionnaire-8) and usability (System Usability Scale-10). We also investigated the indicators of intervention adherence using use metrics (eg, the number of completed sessions). Our secondary goal was to explore the changes in perceived stress (Perceived Stress Scale-10), depressive symptoms (Patient Health Questionnaire-9), and quality of life (EQ-5D-5L scale) from baseline to posttest assessment. In addition, we conducted semistructured interviews with intervention completers and noncompleters to understand user experiences in depth. For all primary outcomes, descriptive statistics were calculated. Changes from baseline to posttest assessment were examined using 2-tailed paired sample t tests or the Wilcoxon signed rank test. Qualitative data were analyzed using thematic analysis.ResultsOf 436 eligible students, 307 (70.4%) students started using the intervention. Overall, 25.7% (79/307) completed the core sessions (ie, sessions 1-3) and posttest assessment. A substantial proportion of the students (228/307, 74.3%) did not complete the core sessions or the posttest assessment. Students who completed the core sessions reported high satisfaction (mean 25.78, SD 3.30) and high usability of the intervention (mean 86.01, SD 10.25). Moreover, this group showed large reductions in perceived stress (Cohen d=0.80) and moderate improvements in depression score (Cohen d=0.47) and quality of life (Cohen d=-0.35) from baseline to posttest assessment. Qualitative findings highlight that several personal and intervention-related factors play a role in user experience.ConclusionsThe internet-based stress management intervention seems to be feasible, acceptable, and possibly effective for some university students with elevated stress levels. However, given the high dropout rate and qualitative findings, several adjustments in the content and features of the intervention are needed to maximize the user experience and the impact of the intervention.Trial Registration: Netherlands Trial Register 8686; https://onderzoekmetmensen.nl/nl/trial/20889.International Registered Report Identifier (IRRID): RR2-10.1016/j.invent.2021.100369.</p

Age-related improvement in complex language comprehension: Results of a cross-sectional study with 361 children aged 5 to 15

We investigated age-related improvement in speed and accuracy of complex language comprehension with 361 children attending kindergarten and the 2nd, 4th, 6th, 7th, and 8th grades. Language comprehension was measured using both the neuropsychological procedure proposed by Luria (1966, 1980) and an adapted version of the Token Test. Levels of short-term memory and verbal intelligence were controlled for in the evaluation of language comprehension. The findings show that the accuracy of language comprehension continued to develop until the 6th grade, whereas the speed of language comprehension continued to improve up until the 7th grade. We thus conclude that the complex language comprehension of children is not fully developed until early adolescence. We further contend that the speed of complex language comprehension appears to be more sensitive than accuracy with respect to measuring developmental differences