228 research outputs found

    Transforms of pseudo-Boolean random variables

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    As in earlier works, we consider {0, 1}n as a sample space with a probability measure on it, thus making pseudo-Boolean functions into random variables. Under the assumption that the coordinate random variables are independent, we show it is very easy to give an orthonormal basis for the space of pseudo-Boolean random variables of degree at most k. We use this orthonormal basis to find the transform of a given pseudo-Boolean random variable and to answer various least squares minimization questions. © 2009 Elsevier B.V. All rights reserved

    Diagnostic Accuracy and Acceptability of the Primary Care Posttraumatic Stress Disorder Screen for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) among US Veterans

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    Importance: Posttraumatic stress disorder (PTSD) is a serious mental health disorder that can be effectively treated with empirically based practices. PTSD screening is essential for identifying undetected cases and providing patients with appropriate care. Objective: To determine whether the Primary Care PTSD screen for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PC-PTSD-5) is a diagnostically accurate and acceptable measure for use in Veterans Affairs (VA) primary care clinics. Design, Setting, and Participants: This cross-sectional, diagnostic accuracy study enrolled participants from May 19, 2017, to September 26, 2018. Participants were recruited from primary care clinics across 2 VA Medical Centers. Session 1 was conducted in person, and session 2 was completed within 30 days via telephone. A consecutive sample of 1594 veterans, aged 18 years or older, who were scheduled for a primary care visit was recruited. Data analysis was performed from March 2019 to August 2020. Exposures: In session 1, participants completed a battery of questionnaires. In session 2, a research assistant administered the PC-PTSD-5 to participants, and then a clinician assessor blind to PC-PTSD-5 results conducted a structured diagnostic interview for PTSD. Main Outcomes and Measures: The range of PC-PTSD-5 cut points overall and across gender was assessed, and diagnostic performance was evaluated by calculating weighted Îș values. Results: In total, 495 of 1594 veterans (31%) participated, and 396 completed all measures and were included in the analyses. Participants were demographically similar to the VA primary care population (mean [SD] age, 61.4 [15.5] years; age range, 21-93 years) and were predominantly male (333 participants [84.1%]) and White (296 of 394 participants [75.1%]). The PC-PTSD-5 had high levels of diagnostic accuracy for the overall sample (area under the receiver operating characteristic curve [AUC], 0.927; 95% CI, 0.896-0.959), men (AUC, 0.932; 95% CI, 0.894-0.969), and women (AUC, 0.899, 95% CI, 0.824-0.974). A cut point of 4 ideally balanced false negatives and false positives for the overall sample and for men. However, for women, this cut point resulted in high numbers of false negatives (6 veterans [33.3%]). A cut point of 3 fit better for women, despite increasing the number of false positives. Participants rated the PC-PTSD-5 as highly acceptable. Conclusions and Relevance: The PC-PTSD-5 is an accurate and acceptable screening tool for use in VA primary care settings. Because performance parameters will change according to sample, clinicians should consider sample characteristics and screening purposes when selecting a cut point

    Trauma Exposure and Transdiagnostic Distress: Examining Shared and PTSD-Specific Associations

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    Dimensional models of psychopathology suggest that the causes and consequences of psychopathology are attributable to a combination of syndrome specific and transdiagnostic features. There is considerable evidence that trauma exposure confers risk for a wide range of psychiatric conditions, yet no previous work has specifically examined the higher-order effects of trauma exposure within a structural model. We examined transdiagnostic and PTSD-specific associations with multiple forms of trauma exposure within a nation-wide sample (N = 1,649; 50% female) of military Veterans over-selected for posttraumatic stress disorder (PTSD). A higher-order Distress variable was estimated using PTSD, major depressive disorder (MDD), and generalized anxiety disorder (GAD) symptoms as indicators. A structural equation model spanning three measurement time points over an average of 3.85 years was then used to examine the unique roles of higher-order Distress and PTSD residual variance in accounting for the relations between trauma exposure and psychosocial impairment. Results suggest that the association between trauma exposure and PTSD symptoms is primarily mediated by higher-order Distress, but that PTSD severity does have a significant association with trauma exposure independent of Distress. Both higher-order Distress and PTSD-specific variance were necessary to account for the association between trauma exposure and future functional impairment. This work suggests there may be shared etiology linking cumulative trauma exposure and a range of internalizing symptoms. Continued application of higher-order dimensional models is needed to provide a more comprehensive understanding of the consequences of trauma exposure

    Mental Health Service Utilization before and after Receipt of a Service‐Connected Disability Award for PTSD: Findings from a National Sample

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    Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146624/1/hesr12859.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146624/2/hesr12859-sup-0001-AppendixSA1.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146624/3/hesr12859_am.pd

    Bilinear modulation models for seasonal tables of counts

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    We propose generalized linear models for time or age-time tables of seasonal counts, with the goal of better understanding seasonal patterns in the data. The linear predictor contains a smooth component for the trend and the product of a smooth component (the modulation) and a periodic time series of arbitrary shape (the carrier wave). To model rates, a population offset is added. Two-dimensional trends and modulation are estimated using a tensor product B-spline basis of moderate dimension. Further smoothness is ensured using difference penalties on the rows and columns of the tensor product coefficients. The optimal penalty tuning parameters are chosen based on minimization of a quasi-information criterion. Computationally efficient estimation is achieved using array regression techniques, avoiding excessively large matrices. The model is applied to female death rate in the US due to cerebrovascular diseases and respiratory diseases

    Clinical outcomes after anterior cruciate ligament injury: panther symposium ACL injury clinical outcomes consensus group

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    © 2020, The Author(s). Purpose: A stringent outcome assessment is a key aspect for establishing evidence-based clinical guidelines for anterior cruciate ligament (ACL) injury treatment. The aim of this consensus statement was to establish what data should be reported when conducting an ACL outcome study, what specific outcome measurements should be used and at what follow-up time those outcomes should be assessed. Methods: To establish a standardized approach to assessment of clinical outcome after ACL treatment, a consensus meeting including a multidisciplinary group of ACL experts was held at the ACL Consensus Meeting Panther Symposium, Pittsburgh, PA; USA, in June 2019. The group reached consensus on nine statements by using a modified Delphi method. Results: In general, outcomes after ACL treatment can be divided into four robust categories—early adverse events, patient-reported outcomes, ACL graft failure/recurrent ligament disruption and clinical measures of knee function and structure. A comprehensive assessment following ACL treatment should aim to provide a complete overview of the treatment result, optimally including the various aspects of outcome categories. For most research questions, a minimum follow-up of 2 years with an optimal follow-up rate of 80% is necessary to achieve a comprehensive assessment. This should include clinical examination, any sustained re-injuries, validated knee-specific PROs and Health-Related Quality of Life questionnaires. In the mid- to long-term follow-up, the presence of osteoarthritis should be evaluated. Conclusion: This consensus paper provides practical guidelines for how the aforementioned entities of outcomes should be reported and suggests the preferred tools for a reliable and valid assessment of outcome after ACL treatment. Level of evidence: V

    Multiculturalism and moderate secularism

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    What is sometimes talked about as the ‘post-secular’ or a ‘crisis of secularism’ is, in Western Europe, quite crucially to do with the reality of multiculturalism. By which I mean not just the fact of new ethno-religious diversity but the presence of a multiculturalist approach to this diversity, namely: the idea that equality must be extended from uniformity of treatment to include respect for difference; recognition of public/private interdependence rather than dichotomized as in classical liberalism; the public recognition and institutional accommodation of minorities; the reversal of marginalisation and a remaking of national citizenship so that all can have a sense of belonging to it. I think that equality requires that this ethno-cultural multiculturalism should be extended to include state-religion connexions in Western Europe, which I characterise as ‘moderate secularism’, based on the idea that political authority should not be subordinated to religious authority yet religion can be a public good which the state should assist in realising or utilising. I discuss here three multiculturalist approaches that contend this multiculturalising of moderate secularism is not the way forward. One excludes religious groups and secularism from the scope of multiculturalism (Kymlicka); another largely limits itself to opposing the ‘othering’ of groups such as Jews and Muslims (Jansen); and the third argues that moderate secularism is the problem not the solution (Bhargava)
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