A framework for power analysis using a structural equation modelling procedure

BACKGROUND: This paper demonstrates how structural equation modelling (SEM) can be used as a tool to aid in carrying out power analyses. For many complex multivariate designs that are increasingly being employed, power analyses can be difficult to carry out, because the software available lacks sufficient flexibility. Satorra and Saris developed a method for estimating the power of the likelihood ratio test for structural equation models. Whilst the Satorra and Saris approach is familiar to researchers who use the structural equation modelling approach, it is less well known amongst other researchers. The SEM approach can be equivalent to other multivariate statistical tests, and therefore the Satorra and Saris approach to power analysis can be used. METHODS: The covariance matrix, along with a vector of means, relating to the alternative hypothesis is generated. This represents the hypothesised population effects. A model (representing the null hypothesis) is then tested in a structural equation model, using the population parameters as input. An analysis based on the chi-square of this model can provide estimates of the sample size required for different levels of power to reject the null hypothesis. CONCLUSIONS: The SEM based power analysis approach may prove useful for researchers designing research in the health and medical spheres

Racial and Ethnic Disparities in Opioid Use for Adolescents at US Emergency Departments

Background Racial/ethnic disparities in the use of opioids to treat pain disorders have been previously reported in the emergency department (ED). Further research is needed to better evaluate the impact race/ethnicity may have on the use of opioids in adolescents for the management of pain disorders in the ED. Methods This was a cross-sectional study using data from the National Hospital Ambulatory Medical Care Survey from 2006 to 2016. Multivariate models were used to evaluate the role of race/ethnicity in the receipt of opioid agonists while in the ED. All ED visits with patients aged 11–21 years old were analyzed. Races/ethnicities were stratified as non-Hispanic Whites, non-Hispanic Blacks, and Hispanics. In addition to race, statistical analysis included the following covariates: pain score, pain diagnosis, age, region, sex, and payment method. Results There was a weighted total of 189,256,419 ED visits. Those visits involved 109,826,315 (58%) non-Hispanic Whites, 46,314,977 (24%) non-Hispanic Blacks, and 33,115,127 (18%) Hispanics, with 21.6% (95% CI, 21.1%-22.1), 15.2% (95% CI, 14.6–15.9%), and 17.4% (95% CI, 16.5–18.2%) of those visits reporting use of opioids, respectively. Regardless of age, sex, and region, non-Hispanic Whites received opioids at a higher rate than non-Hispanic Blacks and Hispanics. Based on diagnosis, non-Hispanic Whites received opioids at a higher rate in multiple pain diagnoses. Additionally, non-Hispanic Blacks and Hispanics were less likely to receive an opioid when reporting moderate pain (aOR = 0.738, 95% CI 0.601–0.906, aOR = 0.739, 95% CI 0.578–0.945, respectively) and severe pain (aOR = 0.580, 95% CI 0.500–0.672, aOR = 0.807, 95% CI 0.685–0.951, respectively) compared to non-Hispanic Whites. Conclusions Differences in the receipt of opioid agonists in EDs among the races/ethnicities exist, with more non-Hispanic Whites receiving opioids than their minority counterparts. Non-Hispanic Black women may be an especially marginalized population. Further investigation into sex-based and regional differences are needed

The Ursinus Weekly, March 21, 1974

U.C. hosts high schools at lively Model U.N. • Four soloists to be featured in Ursinus Easter performance of the “Messiah” by Handel • Annual science fair will be held over vacation • Chessmen dust pieces in preparation for tourney • Editorial: The free press beats cheap talk, Happy spring…and some parting remarks • Alumni corner: Shollenberger sabbatical; Stimulating situation • Alpha-Omega players to present “Diary” in April • The Zodiac: What is an Aquarian like? • Socratic Club is introduced to quiet Quaker faith • Poverty seen as the villain in mental subnormality, visiting psychologist says • Bearettes leave stuffy H.H. for the outdoors • Gymnastics team places first • Pi Nu Epsilon fraternity takes seventeen membershttps://digitalcommons.ursinus.edu/weekly/1013/thumbnail.jp

Evaluating the 0–10 Point Pain Scale on Adolescent Opioid Use in US Emergency Departments

Objective: To evaluate trends in national emergency department (ED) adolescent opioid use in relation to reported pain scores. Methods: A retrospective, cross-sectional analysis on National Hospital Ambulatory Medical Care Survey (NHAMCS) data was conducted on ED visits involving patients aged 11–21 from 2008–2017. Crude observational counts were extrapolated to weighted estimates matching total population counts. Multivariate models were used to evaluate the role of a pain score in the reported use of opioids. Anchors for pain scores were 0 (no pain) and 10 (worst pain imaginable). Results: 31,355 observations were captured, which were extrapolated by the NHAMCS to represent 162,515,943 visits nationwide. Overall, patients with a score of 10 were 1.35 times more likely to receive an opioid than patients scoring a 9, 41.7% (CI95 39.7–43.8%) and 31.0% (CI95 28.8–33.3%), respectively. Opioid use was significantly different between traditional pain score cutoffs of mild (1–3) and moderate pain (4–6), where scores of 4 were 1.76 times more likely to receive an opioid than scores of 3, 15.5% (CI95 13.7–17.3%) and 8.8% (CI95 7.1–10.6%), respectively. Scores of 7 were 1.33 times more likely to receive opioids than scores of 6, 24.7% (CI95 23.0–26.3%) and 18.5% (CI95 16.9–20.0%), respectively. Fractures had the highest likelihood of receiving an opioid, as 49.2% of adolescents with a fracture received an opioid (CI95 46.4–51.9%). Within this subgroup, only adolescents reporting a fracture pain score of 10 had significantly higher opioid use than adjacent pain scores, where fracture patients scoring a 10 were 1.4 times more likely to use opioids than those scoring 9, 82.2% (CI95 76.1–88.4%) and 59.8% (CI95 49.0–70.5%), respectively. Conclusions: While some guidelines in the adult population have revised cut-offs and groupings of the traditional tiers on a 0–10 point pain scale, the adolescent population may also require further examination to potentially warrant a similar adjustment

Speech, language, and reading in 10-year-olds with cleft: Associations with teasing, satisfaction with speech, and psychological adjustment

© 2017 American Cleft Palate-Craniofacial Association. Background: Despite the use of multidisciplinary services, little research has addressed issues involved in the care of those with cleft lip and/or palate across disciplines. The aim was to investigate associations between speech, language, reading, and reports of teasing, subjective satisfaction with speech, and psychological adjustment. Design: Cross-sectional data collected during routine, multidisciplinary assessments in a centralized treatment setting, including speech and language therapists and clinical psychologists. Participants: Children with cleft with palatal involvement aged 10 years from three birth cohorts (N = 170) and their parents. Outcome Measures: Speech: SVANTE-N. Language: Language 6-16 (sentence recall, serial recall, vocabulary, and phonological awareness). Reading: Word Chain Test and Reading Comprehension Test. Psychological measures: Strengths and Difficulties Questionnaire and extracts from the Satisfaction With Appearance Scale and Child Experience Questionnaire. Results: Reading skills were associated with self- and parent-reported psychological adjustment in the child. Subjective satisfaction with speech was associated with psychological adjustment, while not being consistently associated with speech therapists' assessments. Parent-reported teasing was found to be associated with lower levels of reading skills. Having a medical and/or psychological condition in addition to the cleft was found to affect speech, language, and reading significantly. Conclusions: Cleft teams need to be aware of speech, language, and/or reading problems as potential indicators of psychological risk in children with cleft. This study highlights the importance of multiple reports (self, parent, and specialist) and a multidisciplinary approach to cleft care and research

Measuring urban social sustainability:Scale development and validation

Despite the significant role of social sustainability in the sustainable development agenda, there is a lack of research to clearly define and fully operationalise the concept of urban social sustainability. The aim of this study is to contribute to the existing literature by developing a comprehensive measurement scale to assess urban social sustainability at the neighbourhood level. We argue that urban social sustainability is a multidimensional concept that incorporates six main dimensions of social interaction, sense of place, social participation, safety, social equity and neighbourhood satisfaction. Failure to consider each of these dimensions may lead to an incomplete picture of social sustainability. Validity, reliability and dimensionality of the urban social sustainability scale are examined using factor analysis. We also illustrate the application of the urban social sustainability scale by investigating the influence of quality of design, as one of the least studied factors of urban form, on different dimensions of social sustainability. The paper uses data collected from the household questionnaire survey in a sample of 251 respondents from five case study neighbourhoods of Dunedin city, New Zealand. This study provides new evidence on the significance of improving neighbourhood quality of design and its positive and significant relationship with different dimensions of social sustainability and the overall social sustainability