Psychometric Evaluation of an Instrument to Measure Prospective Pregnancy Preferences: The Desire to Avoid Pregnancy Scale.

BACKGROUND:Existing approaches to measuring women's pregnancy intentions suffer important limitations, including retrospective assessment, overly simple categories, and a presumption that all women plan pregnancies. No psychometrically valid scales exist to prospectively measure the ranges of women's pregnancy preferences. MATERIALS AND METHODS:Using a rigorous construct modeling approach, we developed a scale to measure desire to avoid pregnancy. We developed 60 draft items from existing research, assessed comprehension through 25 cognitive interviews, and administered items in surveys with 594 nonpregnant women in 7 primary and reproductive health care facilities in Arizona, New Jersey, New Mexico, South Carolina, and Texas in 2016-2017. We used item response theory to reduce the item set and assess the scale's reliability, internal structure validity, and external validity. Items were included based on fit to a random effects multinomial logistic regression model (partial credit item response model), correspondence of item difficulty with participants' pregnancy preference levels, and consistency of each item's response options with overall scale scores. RESULTS:The 14 final items covered 3 conceptual domains: cognitive preferences, affective feelings, and practical consequences. Items fit the unidimensional model, with a separation reliability of 0.90 (Cronbach α: 0.95). The scale met established criteria for internal validity, including correspondence between each item's response categories and overall scale scores. We found no important differential item functioning by participant characteristics. CONCLUSIONS:A robust measure is available to prospectively measure desire to avoid pregnancy. The measure can aid in identifying women who could benefit from contraceptive care and research on less desired pregnancy

Benefits and Risks of Weight-Loss Treatment for Older, Obese Women

Background: A key issue in the treatment of obesity in older adults is whether the health benefits of weight loss outweigh the potential risks with respect to musculoskeletal injury. Objective: To compare change in weight, improvements in metabolic risk factors, and reported musculoskeletal adverse events in middle-aged (50-59 years) and older (65-74 years), obese women. Materials and methods: Participants completed an initial 6-month lifestyle intervention for weight loss, comprised of weekly group sessions, followed by 12 months of extended care with biweekly contacts. Weight and fasting blood samples were assessed at baseline, month 6, and month 18; data regarding adverse events were collected throughout the duration of the study. Results: Both middle-aged (n = 162) and older (n = 56) women achieved significant weight reductions from baseline to month 6 (10.1 +/- 0.68 kg and 9.3 +/- 0.76 kg, respectively) and maintained a large proportion of their losses at month 18 (7.6 +/- 0.87 kg and 7.6 +/- 1.3 kg, respectively); there were no significant differences between the two groups with respect to weight change. Older women further experienced significant reductions in systolic blood pressure, HbA(1c), and C-reactive protein from baseline to month 6 and maintained these improvements at month 18. Despite potential safety concerns, we found that older women were no more likely to experience musculoskeletal adverse events during the intervention as compared with their middle-aged counterparts. Conclusion: These results suggest that older, obese women can experience significant health benefits from lifestyle treatment for obesity, including weight loss and improvements in disease risk factors. Further investigation of the impact of weight loss on additional health-related parameters and risks (eg, body composition, muscular strength, physical functioning, and injuries) in older adults is needed.National Heart, Lung and Blood Institute R18HL73326University of FloridaDivision of Statistics and Scientific Computatio

Recertification and Reentry to Practice for Nurse Anesthetists: Determining Core Competencies and Evaluating Performance via High-Fidelity Simulation Technology

Introduction The National Board of Certification and Recertification for Nurse Anesthetistsaddressed a barrier to return to practice of uncertified practitioners by replacing required direct patient care experiences with high-fidelity simulation. Objectives The aims of this study were to: (a) validate a set of clinical activities for their relevance to reentry and determine if they could be replicated using simulation, (b) evaluate the content validity of an existing simulation scenario containing the proposed clinical activities and determine its substitutability for a clinical practicum, and (c) evaluate the validity of two methods to assess simulation performance. Methods A modified Delphi method incorporating an autonomous, anonymous, three-round online survey process using three unique expert certified registered nurse anesthetists groups was used to address each study aim. Results Twenty-seven clinical activities gained consensus as necessary to be assessed in the simulation. All 14 survey questions used to determine simulation content validity exceeded the minimum content validity index (CVI) value of 0.78, with a mean CVI of 0.99. The global rating scale CVI and the competency checklist CVI were 0.83 and 1.0, respectively. Conclusion The findings add to the existing literature supporting the utility of simulation for high-stakes provider assessment and certification

An analytic framework for exploring sampling and observation process biases in genome and phenome‐wide association studies using electronic health records

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155932/1/sim8524.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155932/2/SIM8524-sup-0001-supinfo.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155932/3/sim8524_am.pd

Shape dependence of two-cylinder Renyi entropies for free bosons on a lattice

Universal scaling terms occurring in Renyi entanglement entropies have the potential to bring new understanding to quantum critical points in free and interacting systems. Quantitative comparisons between analytical continuum theories and numerical calculations on lattice models play a crucial role in advancing such studies. In this paper, we exactly calculate the universal two-cylinder shape dependence of entanglement entropies for free bosons on finite-size square lattices, and compare to approximate functions derived in the continuum using several different ansatzes. Although none of these ansatzes are exact in the thermodynamic limit, we find that numerical fits are in good agreement with continuum functions derived using the AdS/CFT correspondence, an extensive mutual information model, and a quantum Lifshitz model. We use fits of our lattice data to these functions to calculate universal scalars defined in the thin-cylinder limit, and compare to values previously obtained for the free boson field theory in the continuum.Comment: 7 pages, 5 figures, 1 tabl

Historical changes in thermoregulatory traits of alpine butterflies reveal complex ecological and evolutionary responses to recent climate change

Abstract Background Trait evolution and plasticity are expected to interactively influence responses to climate change, but rapid changes in and increased variability of temperature may limit evolutionary responses. We use historical specimens to document changes in the size and thermoregulatory traits of a montane butterfly, Colias meadii, in Colorado, USA over the past 60 years (1953–2012). We quantify forewing wing length, ventral wing melanin that increases solar absorption, and the length of thorax setae that reduces convective heat loss. Results The mean of all three traits has increased during this time period despite climate warming. Phenological shifts may have extended the active season earlier at low elevations and later at high elevations, increasing exposure to cool temperatures and selecting for increases in thermoregulatory traits. Fitness increases at higher elevations due to warming could also increase thermoregulatory traits. Warmer temperatures during pupal development and later flight dates in the season are associated with decreased wing melanin, indicating a role of phenotypic plasticity in historical trait changes. Conclusions Phenotypic shifts result from a complex interplay of ecological and evolutionary responses to climate change. Environmental variability within and across seasons can limit the evolutionary responses of populations to increasing mean temperatures during climate change

Validation of the Equations Used in Determining Dry Matter Intake, and Metabolizable Protein Requirements for Finishing Lambs as used in the Sheep Companion Module to BRaNDS

The growth equations published in the 2006 NRC “Nutrient Requirements of Small Ruminants” along with the additions added to these equations when used in the Sheep Companion Module to BRaNDS appear to provide reasonable estimations of performance of feeder lambs