Temporal trends in symptom experience predict the accuracy of recall PROs

Objective - Patient-reported outcome measures with reporting periods of a week or more are often used to evaluate the change of symptoms over time, but the accuracy of recall in the context of change is not well understood. This study examined whether temporal trends in symptoms that occur during the reporting period impact the accuracy of 7-day recall reports. Methods - Women with premenstrual symptoms (n = 95) completed daily reports of anger, depression, fatigue, and pain intensity for 4 weeks, as well as 7-day recall reports at the end of each week. Latent class growth analysis was used to categorize recall periods based on the direction and rate of change in the daily reports. Agreement (level differences and correlations) between 7-day recall and aggregated daily scores was compared for recall periods with different temporal trends. Results - Recall periods with positive, negative, and flat temporal trends were identified and they varied in accordance with weeks of the menstrual cycle. Replicating previous research, 7-day recall scores were consistently higher than aggregated daily scores, but this level difference was more pronounced for recall periods involving positive and negative trends compared with flat trends. Moreover, correlations between 7-day recall and aggregated daily scores were lower in the presence of positive and negative trends compared with flat trends. These findings were largely consistent for anger, depression, fatigue, and pain intensity. Conclusion - Temporal trends in symptoms can influence the accuracy of recall reports and this should be considered in research designs involving change

Psychometric characteristics of daily diaries for the Patient-Reported Outcomes Measurement Information System (PROMIS®): a preliminary investigation

Purpose - The Patient-Reported Outcomes (PRO) Measurement Information System (PROMIS®) has developed assessment tools for numerous PROs, most using a 7-day recall format. We examined whether modifying the recall period for use in daily diary research would affect the psychometric characteristics of several PROMIS measures. Methods - Daily versions of short-forms for three PROMIS domains (pain interference, fatigue, depression) were administered to a general population sample (n = 100) for 28 days. Analyses used multilevel item response theory (IRT) models. We examined differential item functioning (DIF) across recall periods by comparing the IRT parameters from the daily data with the PROMIS 7-day recall IRT parameters. Additionally, we examined whether the IRT parameters for day-to-day within-person changes are invariant to those for between-person (cross-sectional) differences in PROs. Results - Dimensionality analyses of the daily data suggested a single dimension for each PRO domain, consistent with PROMIS instruments. One-third of the daily items showed uniform DIF when compared with PROMIS 7-day recall, but the impact of DIF on the scale level was minor. IRT parameters for within-person changes differed from between-person parameters for 3 depression items, which were more sensitive for measuring change than between-person differences, but not for pain interference and fatigue items. Notably, mean scores from daily diaries were significantly lower than the PROMIS 7-day recall norms. Conclusions - The results provide initial evidence supporting the adaptation of PROMIS measures for daily diary research. However, scores from daily diaries cannot be directly interpreted on PROMIS norms established for 7-day recall

Cost-effectiveness of secondary screening modalities for hypertension

Background: Clinic-based blood pressure (CBP) has been the default approach for the diagnosis of hypertension, but patients may be misclassified because of masked hypertension (false negative) or ‘white coat’ hypertension (false positive). The incorporation of other diagnostic modalities, such as home blood pressure monitoring (HBPM) and ambulatory blood pressure monitoring (ABPM), holds promise to improve diagnostic accuracy and subsequent treatment decisions. Materials and methods: We reviewed the literature on the costs and cost-effectiveness of adding HBPM and ABPM to routine blood pressure screening in adults. We excluded letters, editorials, and studies of pregnant and/or pre-eclamptic patients, children, and patients with specific conditions (e.g. diabetes). Results: We identified 14 original, English language studies that included cost outcomes and compared two or more modalities. ABPM was found to be cost saving for diagnostic confirmation following an elevated CBP in six studies. Three of four studies found that adding HBPM to an elevated CBP was also cost-effective. Conclusion: Existing evidence supports the cost-effectiveness of incorporating HBPM or ABPM after an initial CBP-based diagnosis of hypertension. Future research should focus on their implementation in clinical practice, long-term economic values, and potential roles in identifying masked hypertension

The current practice of intra-aortic balloon counterpulsation: results from the Benchmark Registry

OBJECTIVES This study presents clinical data from the first large registry of aortic counterpulsation, a computerized database that incorporates prospectively gathered data on indications for intra-aortic balloon counterpulsation (IABP) use, patient demographics, concomitant medication and in-hospital outcomes and complications. BACKGROUND The intra-aortic balloon pump (IABP) is widely used to provide circulatory support for patients experiencing hemodynamic instability due to myocardial infarction, cardiogenic shock, or in very high risk patients undergoing angioplasty or coronary artery bypass grafting. METHODS Between June 1996 and August 2000, 203 hospitals worldwide (90% U.S., 10% non-U.S.) collected 16,909 patient case records (68.8% men, 31.2% women; mean age 65.9 ± 11.7 years). RESULTS The most frequent indications for use of IABP were as follows: to provide hemodynamic support during or after cardiac catheterization (20.6%), cardiogenic shock (18.8%), weaning from cardiopulmonary bypass (16.1%), preoperative use in high risk patients (13.0%) and refractory unstable angina (12.3%). Major IABP complications (major limb ischemia, severe bleeding, balloon leak, death directly due to IABP insertion or failure) occurred in 2.6% of cases; in-hospital mortality was 21.2% (11.6% with the balloon in place). Female gender, high age and peripheral vascular disease were independent predictors of a serious complication. CONCLUSIONS This registry provides a useful tool for monitoring the evolving practice of IABP. In the modern-day practice of IABP, complication rates are generally low, although in-hospital mortality remains high. There is an increased risk of major complications in women, older patients and patients with peripheral vascular disease

Dramatic Shape Sensitivity of Directional Emission Patterns from Similarly Deformed Cylindrical Polymer Lasers

Recent experiments on similarly shaped polymer micro-cavity lasers show a dramatic difference in the far-field emission patterns. We show for different deformations of the ellipse, quadrupole and hexadecapole that the large differences in the far-field emission patterns is explained by the differing ray dynamics corresponding to each shape. Analyzing the differences in the appropriate phase space for ray motion, it is shown that the differing geometries of the unstable manifolds of periodic orbits are the decisive factors in determining the far-field pattern. Surprisingly, we find that strongly chaotic ray dynamics is compatible with highly directional emission in the far-field.Comment: 14 pages, 16 figures (eps), RevTeX 4, submitted to JOSA

An exploratory study on the value of service learning projects and their impact on community service involvement and critical thinking

Purpose - This exploratory study attempts to capture some of the principal benefits/factors attributable to service learning/community service projects, from a student perspective. Design/methodology/approach - A sample of 67 males and 83 females (16 graduate, 71 seniors, and 63 juniors) participated in the study. Findings - Students believe that their college experience is preparing them for the job market, that critical thinking has been enhanced, and that their college academic experience has emphasized community service upon graduation. Practical implications - The results increase one's knowledge of the benefits of service learning since so much emphasis is currently being placed on improving the critical thinking and problem-solving ability of undergraduate business students. Originality/value - Practitioners would be interested in understanding the impact that service learning can have on the problem-solving ability of potential employees. If additional research could advance the proposition that students with service learning experience are generally superior in terms of their problem-solving skills to students with no similar experience, then evidence of a service learning component on a student résumeé suddenly adds value to the employer

The Merging System Am 2049-691

Spectroscopic and photometric observations of the peculiar object AM 2049-691 are presented here. Its systemic velocity is V(GSR) = (10956 +-30) km/s, and the derived distance (H(0) = 75 km/s/Mpc) results 146 Mpc. A bridge is observed between two very distinct nuclei whose separation is about 10 kpc, as well as two tails that emerge from the extremes SW and NE of the main body and extend up to 41 and 58 kpc respectively. The spectral characteristics of the all observed zones are typical of H II regions of low excitation. The internal reddening is quit high, particularly in the NE nucleus. All the derived equivalent widths of the H(alpha)+[N II] lines indicate enhanced star formation compared with isolated galaxies, specially in the NE nucleus; the equivalent width corresponding to the integrated spectrum reflects starburst activity in the whole object, and is compatible with a merger of two disk galaxies. All the observed characteristics of AM 2049-691 indicate it is a merger, where a overabundance of nitrogen is detected in one of the nuclei, which has the most evolved population and would be the most massive one. The detected total IR emission is not very high. The integrated total color B - V corresponds to a Sc-Scd galaxy and its average integrated population is about F7 type. Indicative B - V colors of the nuclei, corrected for internal absorption, are in agreement with the spectroscopic results. The central radial velocity dispersions at the nuclei suggest that the most massive galaxy would be the progenitor of the SW component. The observed radial velocity curve shows the presence of two subsystems, each one associated with a different nucleus.Comment: 5 pages, 4 figure