Computerized Adaptive Testing Research Articles

Implementation Barriers Encountered During a Universal Suicide Screening Program in Pediatric Emergency Departments.

Because understanding barriers to universal suicide risk screening in pediatric emergency departments (PEDs) may improve both identification and management of suicidal behaviors and ideation, this study assessed barriers to a quality improvement initiative examining the use of a novel computerized adaptive test (CAT), the Kiddie-CAT, in 2 PEDs. Research assistants (RAs) trained in Rapid Assessment Procedures-Informed Clinical Ethnography methods documented barriers related to the environment, individuals, and workflow as encountered during screening shifts, categorizing the barriers' impacts as either general to a screening shift or related to screening an individual youth/caregiver dyad. Using thematic content analysis, investigators further categorized barriers based on type (eg, workflow, language/comprehension, clinician attitudes/behaviors) and relationship to the limited integration of this initiative into clinical protocols. Reasons for refusal and descriptive data on barriers are also reported. Individual screen barriers were most often related to workflow (22.9%) and youth/caregiver language/comprehension challenges (28%). Similarly, workflow issues accounted for 48.2% of all general shift barriers. However, many of these barriers were related to the limited integration of the initiative, as RAs rather than clinical staff conducted the screening. Although this study was limited by a lack of complete integration into clinical protocols and was complicated by the COVID-19 pandemic impacts on PEDs, the findings suggest that considerable attention needs to be directed both to physician education and to workflow issues that could impede universal screening efforts.

Measurement of perceived pressures in psychiatry: paper-and-pencil and computerized adaptive version of the P-PSY35 scale

PurposeFormal coercion in psychiatry is widely studied yet much less is known about pressures patients may experience, partly because of the very few measures available. The goal of this study was to validate the P-PSY35 (Pressures in Psychiatry Scale) and provide a paper-and-pencil and a computerised adaptive test (CAT) to measure pressures experienced by patients in psychiatry.MethodsThe P-PSY35 items were developed with users. Patients were evaluated during psychiatric hospitalisation or through an online survey. Mokken scale analysis and Item response theory (IRT) were used to select and estimate the items parameters. A Monte-Carlo simulation was performed to evaluate the number of items needed to transform the paper-and-pencil test into a reliable psychometric CAT.ResultsA total of 274 patients were assessed. The P-PSY35 demonstrated good internal validity, internal consistency, convergent and divergent validity. The P-PSY35 could be substantially shortened while maintaining excellent reliability using the CAT procedure.ConclusionThe P-PSY35 was developed in collaboration with users. It is a psychometrically rigorous tool designed to measure experienced pressures in French-language. The development and successful validation of the P-PSY35 represent a welcome step towards implementing and evaluating programs aimed at reducing negative consequences of coercion.

Development of mobile CAT for patient feedback on pediatric consultations based on Rasch analysis of online techniques.

The Rasch Rating Scale Model (RSM) is widely used in questionnaire analysis, providing insights into how individuals respond to item-level stimuli. Existing software for Rasch RSM parameter estimation, while powerful, often presents a steep learning curve. An accessible online tool can greatly benefit novice users, particularly students and clinicians, by simplifying the analytical process. This study introduces an online tool, an intuitive online RSM analysis tool designed to facilitate questionnaire data analysis for applied researchers, students, and clinicians. The online tool employs the joint maximum likelihood method for estimation, yielding estimates, standard errors (SE), and fit statistics iteratively. A unique feature of the tool is its ability to visualize estimates on Google Maps with an opacity setting of 0, enhancing data interpretation through a user-friendly interface. This study outlines the estimation process and key features, employing data from 200 proxy participants who answered 20 5-point questions regarding doctor-patient and doctor-family interactions in pediatric consultations. Mobile computerized adaptive testing (CAT) was employed. The online tool offers 5 essential visual displays often utilized in Rasch analyses, including the Wright Map, KIDMAP, category probability curve, performance plot, and differential item functioning (DIF) graph. DIF analysis revealed that 2 items, concerning the doctor attentiveness and empathy toward the child illness, exhibited differences in female proxy participants' responses, indicating lower satisfaction with pediatricians. The online tool emerges as a user-friendly and efficient RSM analysis tool with notable advantages for newcomers, improving data visualization and comprehension. Its capacity to pinpoint key areas of concern, such as gender-related satisfaction disparities among proxy participants, enhances its utility in questionnaire analysis. The online tool holds promise as a valuable resource for researchers, students, and clinicians seeking accessible Rasch analysis solutions.

Research on a machine learning-based adaptive and efficient screening model for psychological symptoms of community correctional prisoners.

Community correction institutions in China frequently employ the Symptom Checklist-90 (SCL-90) and the health survey brief (SF-12) as primary tools for psychological assessment of community correctional prisoners. However, in practical application, the SCL-90 Checklist faces issues such as complex item numbers, overall low cultural level of the subjects, and insufficient professional level of the administrators. The SF-12 health survey brief, as a preliminary screening tool, although only has 12 questions, to some extent simplifies the evaluation process and improves work efficiency, it is prone to missed screening. The research team collected 17-dimensional basic characteristic data and corresponding SCL-90 and SF-12 data from 25,480 samples of community correctional prisoners in Zhejiang Province, China. This study explored the application of multi-label multi-classification algorithms and oversampling techniques in building machine learning models to delve into the correlation between the psychological health risks of community correctional prisoners and their characteristic data. Inspired by computerized adaptive testing (CAT), we constructed an adaptive and efficient screening model for community correctional prisoners through experimental comparisons, based on the binary relevance algorithm with sample oversampling. This screening model personalize the assessment process by dynamically matching participants with the most relevant subset (s) of the nine dimensions of the SCL-90 based on their individual characteristics. Thus, adaptive dynamic simplification and personalized recommendation of the SCL-90 scale between question groups were achieved for the specific group of community correctional prisoners. As a screening tool for psychological symptoms of community correctional prisoners, this model significantly simplifies the number of questions compared to SCL-90, with a simplification rate of up to 65%. However, it achieves this simplification while maintaining excellent performance. The accuracy reached 0.66, with a sensitivity of 0.754, and an F1 score of 0.649. This innovation simplified the assessment process, reduced the assessment time, improved work efficiency, and enhanced the ability to judge the specificity of community correctional prisoners population. Compared to the SF-12, although the simplification rate and accuracy of the model are slightly lower than those of the SF-12, the sensitivity increased by 42.26%, and the F1 score improved by 15.28%. This means the model greatly reduces the possibility of missed screening, effectively preventing prisoners with abnormal psychological or mental states from losing control due to missed screening, and even committing suicide, self injury, or injuring others.

The Impact of ChatGPT on the Development of Vocabulary Knowledge of Saudi EFL Students

This research was piloted to systematically compare the impact of ChatGPT-generated exercises versus traditional exercises on Saudi EFL students’ vocabulary size and the strength of word families. It aimed to answer the following questions: 1) To what extent does the integration of ChatGPT-generated exercises impact Saudi EFL students’ vocabulary size of word families? 2) To what extent does the integration of ChatGPT-generated exercises impact Saudi EFL students’ vocabulary size and strength of word families? This research holds significance because it provides educators with empirical results of the impact of ChatGPT’s role and function on the second language vocabulary development process. Sixty male Saudi students at Jouf University were selected by stratified random sampling. The design of this research is experimental. Consequently, samples were randomly assigned to different experimental conditions and groups (i.e., control and treatment groups). Computer-Adaptive Test of Size and Strength, as developed by Laufer and Goldstein (2004), was administered to both groups at the beginning and end of their studies in the IELP course with an interval of four months. The collected results from all participants (N=60) from both groups and in both intervals (i.e., pre-test and post-test) were clearly and concisely imported to Statistical Package for the Social Sciences SPSS. Multivariate Analysis of Variance was conducted. Results revealed that Saudi EFL students’ vocabulary development improved significantly in both groups. However, participants in the experimental group who experienced ChatGPT-generated exercises notably surpassed that of the control group in terms of vocabulary size and strength of word families.

Concurrent Validity of PROMIS and LD-SRS Scores in Pediatric Patients With Lower Limb Differences.

We sought to assess the concurrent validity of select Patient Reported Outcomes Measurement Information System (PROMIS) domains and Limb Deformity-Scoliosis Research Society (LD-SRS) scores. We prospectively administered PROMIS-25 (including anxiety, depression, fatigue, pain interference, peer relationships, and physical function) and LD-SRS questionnaires to 46 consecutive pediatric patients with lower limb differences, presenting to a single surgeon for reconstruction. Concurrent validity between various subdomains of the 2 outcome measures was assessed through Pearson's correlation, with significance defined as P <0.05. The strength of correlation was interpreted by Evans criteria: absolute r value <0.20 indicating very weak correlation; 0.20 to 0.39, weak; 0.40 to 0.59, moderate; 0.60 to 0.79, strong; and 0.8 or greater indicating very strong correlation. The LD-SRS Pain, Function, and Mental Health domains most strongly correlated with the PROMIS pain interference (r=-0.79, P<0.001), physical function (r=0.74, P<0.001), and anxiety (r=-0.68, P <0.001) domains, respectively. In addition, LD-SRS pain strongly correlated with PROMIS physical function (r=0.61, P<0.001) and LD-SRS function with PROMIS pain interference (r=-0.72, P<0.001). All PROMIS domains significantly correlated with total LD-SRS scores. PROMIS pain interference (r=-0.79, P <0.001), physical function (r=0.67, P <0.001), and fatigue (r=-0.60, P <0.001) domains demonstrated the strongest correlations with the total LD-SRS score. The significant concurrent validity between LD-SRS and multiple PROMIS domains suggests considerable overlap, and perhaps redundancy, between these 2 outcome measures. Given the high degree of concordance and the advantage of computer adaptive testing (CAT) in mitigating administrative burden and survey fatigue, along with the ability to compare outcomes across a wider group of children with a variety of underlying diagnoses, select PROMIS domains may be a viable alternative to LD-SRS score for assessing patient-reported outcomes when treating pediatric patients with lower limb deformities. A larger, multi-center study including pediatric patients with lower limb differences from a diverse background, including age, etiology, native language, and ethnicity, would be helpful to externally validate our findings. Level-I.

A two-step item bank calibration strategy based on 1-bit matrix completion for small-scale computerized adaptive testing.

Computerized adaptive testing (CAT) is a widely embraced approach for delivering personalized educational assessments, tailoring each test to the real-time performance of individual examinees. Despite its potential advantages, CAT�s application in small-scale assessments has been limited due to the complexities associated with calibrating the item bank using sparse response data and small sample sizes. This study addresses these challenges by developing a two-step item bank calibration strategy that leverages the 1-bit matrix completion method in conjunction with two distinct incomplete pretesting designs. We introduce two novel 1-bit matrix completion-based imputation methods specifically designed to tackle the issues associated with item calibration in the presence of sparse response data and limited sample sizes. To demonstrate the effectiveness of these approaches, we conduct a comparative assessment against several established item parameter estimation methods capable of handling missing data. This evaluation is carried out through two sets of simulation studies, each featuring different pretesting designs, item bank structures, and sample sizes. Furthermore, we illustrate the practical application of the methods investigated, using empirical data collected from small-scale assessments.

Enhancing the evaluation of physical function following orthopaedic trauma care: comparison of PROMIS Computerized Adaptive Testing and Short Musculoskeletal Function Assessment (SMFA)

OBJECTIVES: To compare measurement properties of Patient-Reported Outcomes Measurement Information System (PROMIS) (Physical Function (PF) and Pain Interference (PI)) computerized adaptive testing (CAT) to traditional Short Musculoskeletal Function Assessment (SMFA) (dysfunction index (DI) and bother index (BI)). To explore factors associated with PROMIS scores. METHODS: Design: Cross-sectional study. Setting: Level-I Trauma Center. Patient Selection Criteria: isolated upper/lower extremity fracture patients were recruited from the orthopaedic trauma outpatient clinic (October 1, 2021 to January 1, 2023). Outcome measures: Correlations (Pearson), reliability (Standard error (SE)(T score), efficiency (amount of information per item(1 – SE2/ Nitems)) and floor/ceiling effects were assessed. An r&gt;0.7 represented high correlation, SE≤2.2 represented sufficient reliability. Factors associated with worse PROMIS scores were also identified. RESULTS: In total, 202 patients completed PROMs at median 98 days follow-up. Correlations between PROMIS-PF and SMFA-DI, and PROMIS-PI and SMFA-BI were -0.84 and 0.65. Reliability was very high for both instruments (mean SE 2.0(PROMIS-PF), SE 2.1(PROMIS-PI) and SE 1.2(SMFA-DI), SE 1.8(SMFA-BI)). Relative efficiency for PROMIS-PF versus SMFA-DI, and PROMIS-PI versus SMFA-BI was 7.8(SD2.5), and 4.1(SD1.7), respectively. Neither PROMIS nor SMFA exhibited floor/ceiling effects. In the multivariable regression analyses, elevated levels of depression, among other factors, showed an (independent) association with worse PROMIS-PF and PROMIS-PI scores. CONCLUSIONS: PROMIS-PF and PROMIS-PI CATs showed a (high and moderate) correlation with SMFA and hence measure a comparable construct of physical function and discomfort. As CATs are much more efficient to administer, they present a compelling alternative to SMFA for evaluating impact of fracture treatment. The relation between symptoms of depression and PROMIS scores emphasizes the importance of psychosocial aspects of health in orthopaedic trauma patients. LEVEL OF EVIDENCE: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Optimizing Educational Assessment: The Practicality of Computer Adaptive Testing (CAT) with an Item Response Theory (IRT) Approach

This research aims to develop a Computer Adaptive Test (CAT) system using the Items Response Theory (IRT) approach. This study is part of developing a web-based system using the Research and Development (R&amp;D) method, employing the Four-D (4-D) model. At its core, this system is similar to a Computer-Based Test (CBT). Still, the critical difference lies in its ability to randomize and provide questions that align with the test-taker's skill levels using the Items Response Theory (IRT) algorithm. The system employs the 3-PL model from the Items Response Theory, considering the difficulty level of questions, the discriminative power of questions, and the likelihood of guessing or interference in the questions. The examination system randomly assigns questions to students based on their responses to previous questions, ensuring that each test-taker receives a unique question sequence. The exam concludes when a test-taker accurately estimates their ability, i.e., SE &lt;= 0.01, or when all questions have been answered. The outcome of this research is a Computer Adaptive Test (CAT) system based on the Items Response Theory (IRT), which can be used to assess students' learning outcomes. This research was implemented in the Multimedia Department of SMK Negeri 1 Gunung Talang, with 90 students as the research sample. The evaluation of the practicality of this system received very high scores, indicating that the Computer Adaptive Test (CAT) system based on the Items Response Theory (IRT) is considered highly practical and effective in achieving the established measurement goals.

Adapting the Person Fit Analysis: Ideas on Detecting Person Misfit in Computerized Adaptive Testing

In this editorial chapter, I aim to summarize findings on person fit analysis in computerized adaptive testing (CAT) from prior research and discuss potential avenues for further research. In item response theory (IRT) applications, person fit quantifies fit of a response pattern to the model (Bradlow &amp; Weiss, 2001, p. 86). Person misfit refers to unexpected response patterns by individuals. There are many potential reasons of misfit including special knowledge (Sinharay, 2016), cheating, guessing (Meijer, 1996), fatigue (Swearingen, 1998), warming up (Meijer, 1996), or faking (Ferrando &amp; Anguiano-Carrasco, 2012). Evaluation of misfit is a significant step for addressing discrepancies within the measurement model. When IRT models are used, evidence of model fit which involves person fit analysis results should be reported (Standard 4.10; AERA, APA &amp; NCME, 2014) as validity evidence to enhance score interpretations. Once misfitting items are identified, corrective steps such as item revision or removal can be implemented. For examinees who exhibit misfit, additional exploration can be undertaken to pinpoint behaviors that might necessitate adjustments to the test program or corrective interventions for particular examinees.

Item response theory and computer adaptive testing of the sexual knowledge scale of the sexual knowledge and attitude test in a college sample

ABSTRACT Our study addresses the limited availability of well-validated scales for assessing general sexual knowledge among college populations. To fill this gap, we examined the psychometric properties of a 41-item sexual knowledge scale derived from the Sexual Knowledge and Attitudes Test – Adolescents (SKAT-A) in a sample of young adults aged 18–25 (N = 1,291). We employed classical test theory (CTT) procedures, followed by item response theory (IRT) and computerized adaptive testing (CAT), to refine the SKAT-A knowledge scale. Both CTT and IRT analyses identified six items for removal due to poor discrimination and difficulty parameters. A confirmatory factor analysis supported a well-defined unidimensional latent trait of sexual knowledge. The results of CAT simulations using dynamic item administration demonstrated the scale’s measurement precision, with moderate test reliability and relatively low standard errors. On average, there was a 54.3% reduction in the number of items administered without compromising scale reliability. This study concludes that the SKAT-A efficiently assesses a unidimensional trait of sexual knowledge in college-attending young adults. It highlights that only a subset of items from the full test bank is necessary to achieve this, providing a practical and reliable tool for assessing sexual knowledge in this population.

Perspectives of Patients and Professionals on Implementing a Computer Adaptive Vision-Related Quality of Life Outcome (CAT-EyeQ) in Clinical Practice.

The CAT-EyeQ is a computer adaptive test (CAT) which measures vision-related quality of life in patients having exudative retinal diseases. The aim of this study is to investigate the usability of the CAT-EyeQ in clinical practice and identify potential barriers and facilitators for implementation (problem analysis). Patients and health care professionals participated in the study regarding the usability of the CAT-EyeQ, and clinic managers and health care professionals were included in the problem analysis for implementation. In total, we conducted 18 semi-structured interviews. The Consolidated Framework for Implementation Research (CFIR) was used to develop the interview guides and to structure results. Six themes were derived from the usability study and problem analysis: (1) quality of the CAT-EyeQ and the applicability to patients' needs and preferences, (2) embedding the CAT-EyeQ in current practice, (3) implementation climate of the eye hospitals, (4) attitude of professionals, (5) engaging and encouraging professionals, and (6) integration of the CAT-EyeQ in health care - needs after piloting. Patients and professionals mentioned that the CAT-EyeQ improved insight into the impact of eye diseases on a patient's daily life, it allowed for more attention on the patient perspective and the structured measurement of vision-related quality of life. The main perceived barriers mentioned by professionals for using the CAT-EyeQ were lack of time and the integration of the patient-reported outcome measure (PROM) results within the electronic patient record (EPR). The CAT-EyeQ, accompanied by an overview of stakeholder perspectives resulting from this implementation study, can now be used in clinical practice.

OS TESTES SITUACIONAIS DE INTELIGÊNCIA EMOCIONAL COMO UM TESTE ADAPTATIVO COMPUTADORIZADO

The present study aimed to assess whether an emotional understanding test (STEU) and an emotional management test (STEM) could benefit from being administered as computer-adaptive tests (CATs) without impacting the validity of the test scores. To this end, 11 item selection algorithms (ISAs) were benchmarked for their bias and efficiency. Two simulation studies were run using the same response patterns from the 688 participants used in the original validation study, the same 11 ISAs, but differed in their stopping rules (SRs). For the first study, one simulation was run for each ISA with the SR being standard error lower than  (ΔSE &lt; ), the most commonly used stopping rule criterion. For the second study, k simulations were run for each ISA, for each test, with the SR being a fixed number of items between 1 and k, where k was the total number of items of the relevant test (32 for the STEU and 30 for the STEM). Results of the first simulation showed that testing with all ISAs resulted in accurate ability estimates, all of them having r &gt; .98 between their estimates and the estimates calculated with the entire test. The first simulation also showed that, using the best performing ISA, 368 (53.5%) participants needed to answer at least one fewer item without loss of validity. The second study showed that the STEU stood to benefit the most, with the mean standard error (MSE) being minimized six items before the end of the test, though ISAs based on the Kullback–Leibler information performed worse. However, these ISAs also displayed slightly less bias, , than the Fisher information-based ones . For the STEM, no ISA minimized MSE levels before the end of the test, but up to six fewer items for the STEM and 15 fewer items for the STEU could be administered with a slightly higher tolerance of ΔSE &lt; . These results indicate that the use of CAT methodology to administer these tests is viable, and EI testing stands to gain from using CAT tests. Future studies should test ISA performance with additional testing constraints.

Efficiency of PROMIS MCAT Assessments for Orthopaedic Care

ABSTRACT Administration of patient-reported outcome measures (PROs), using multidimensional computer adaptive tests (MCATs) has the potential to reduce patient burden, but the efficiency of MCAT depends on the degree to which an individual’s responses fit the psychometric properties of the assessment. Assessing patients’ symptom burden through the administration of MCATs is gaining popularity in clinical settings, especially in orthopeadics where patients reporting low physical functioning and high pain interference may not always report high levels of depression. Are MCATs more efficient and precise than unidimensional CATs in a patient profile where the person-item fit varies between symptoms? Results depend on the item selection algorithm used in the assessments. Constraining item selection algorithm can substantially reduce test lengths where person-item fit is poor. This study demonstrates how MCAT can reduce patient burden in settings where collecting PROs is becoming part of routine care. Abbreviations: PRO: Patient-reported outcome; PROMIS®: Patient-Reported Outcomes Measurement Information System; CAT: Computer Adaptive Test; IRT: item response theory; EHR: electronic health record; UCAT: unidimensional computer adaptive tests; MCAT: multidimensional computer adaptive tests; HRQOL: health-related quality of life; MEPV: minimum expected posterior variance; SE: standard error; RMSE: root mean squared error; EAP: Expected a priori; MPEV-P: minimum expected posterior variance with domain preference; KL: Kullback-Leibler.

When Do Patients Achieve PROMIS Milestones After Rotator Cuff Repair?

Given the variability of the questions asked, the Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) computer adaptive test (CAT) Version 2.0 item bank aids in the evaluation of rotator cuff repair (RCR) rehabilitation by determining when recovery milestones are possible based on the quality of patient responses at certain time points. To assess the time point at which patients with RCR were able to achieve specific functional milestones, determined as positive responses to the 5 most frequently asked items on the PROMIS UE CAT Version 2.0. Case series; Level of evidence, 4. The postoperative PROMIS UE CAT Version 2.0 scores of patients who underwent RCR between February 16, 2017, and July 30, 2019, were reviewed with respect to individual PROMIS item, response, and timing of response. A functional milestone was considered achieved if the patient response was "without any difficulty" or "with a little difficulty" to any of the 5 most frequently asked PROMIS items. The percentage of patients in each monthlong postoperative interval who answered with either response was recorded. The logit generalized estimating equations method was used to analyze the association between milestone achievement for each PROMIS item and predictor variables (age, sex, body mass index, smoking status, race, ethnicity, and employment status). A total of 1131 responses from 371 patients were included. The majority of patients attained milestone achievement on 4 of the 5 most frequently asked PROMIS items at time points ranging from 1 to 5 months postoperatively: "Are you able to carry a shopping bag or briefcase?" (by 1 month), "Are you able to put on and take off a coat or jacket?" (by 3 months), "Are you able to pour liquid from a bottle into a glass?" (by 3 months), and "Are you able to carry a heavy object (over 10 pounds/5 kg)?" (by 5 months). For the item "Are you able to put on a shirt or blouse?", the majority of patients did not achieve the milestone by 1 year. These findings support the application of PROMIS UE CAT Version 2.0 milestone achievement in the shared decision-making process and postoperative monitoring, as patients can use this information to determine when they can return to certain activities and providers can apply these standards to identify patients needing additional clinical support.

Impacts of the Early COVID-19 Pandemic on Depressive Symptoms and Mental Health Among Student-Athletes.

Social distancing protocols due to the COVID-19 pandemic resulted in premature ending of athletic seasons and cancellation of upcoming seasons, placing significant stress on young athletes. Inability to play or forced early retirement has significant consequences on athlete's mental health, as demonstrated by an extensive body of injury literature. We hypothesize that premature suspension and cancellation of athletic events due to the COVID-19 pandemic leads to higher incidence of depressive symptoms among high-school and collegiate athletes. Further, athletes who strongly derive their sense of self-worth centered around athletics would have higher rates of depressive symptoms. High school and collegiate athletes were evaluated for depressive symptoms, emotional health and athletic identity measures through validated assessment instruments from May 2020 through July 2020. The Patient-Reported Outcomes Measurement Information System Depression Computer Adaptive Test (PROMIS-10 Depression CAT), Veterans RAND-12 (VR-12), which comprises both a physical and mental health component, and Athletic Identity Measurement Scale (AIMS) were utilized. Mental health assessments were completed by 515 athletes (52.4% male, 47.6% female; .84.5% collegiate, 15.5% high school). Female athletes scored significantly worse than males on VR-12 mental health assessments, as well as PROMIS-10 Depression scores; however, males scored significantly lower than females on VR-12 physical health assessments, irrespective of education level. Athletes who had strong associations with athletics as central to their personal identity exhibited worse psychologic impact on VR-12 mental health and PROMIS-10 Depression measures and female athletes in this cohort reported greater depressive symptoms than males. Social distancing protocols due to the COVID-19 pandemic have limited athlete's ability to participate in sports at the training and competition level. Higher rates of depressive symptoms in high school and college athletes have resulted among female athletes and those who identify strongly as an athlete.

Autism and neurodevelopmental disability risks in children with tracheostomies and ventilators.

Infants who survive prematurity and other critical illnesses and require continued invasive mechanical ventilation (IMV) postdischarge (at home) are at high risk of developmental delays and disabilities. Studies of extremely preterm cohorts (<28-week gestation) demonstrate rates of 25% for intellectual disability (ID) and 7% for autism spectrum disorder (ASD). Rates of ASD and ID in children with IMV are unknown. This study aimed to determine neurodevelopmental disability risk in a cohort of children with postdischarge IMV. A consecutive series of children with IMV were assessed 1 month, 6 months, and 1 year after discharge. Cognitive, social, and communicative domains were assessed by a Developmental and Behavioral Pediatrician using (1) clinical adaptive test/clinical linguistic and auditory milestone scale (CAT/CLAMS) of the capute scales; (2) pediatric evaluation of disability inventory computer adaptive test (PEDI-CAT); and (3) modified checklist for autism in toddlers, revised (MCHAT-R). Red flag signs and symptoms of ASD using DSM-V criteria were noted. Longitudinal testing was reviewed. Expert consensus impressions of evolving ASD and/or ID were determined. Eighteen children were followed for 1 year; at 1 year, the median age (range) was 23 (17-42) months. Children were 44% male, 33% non-Hispanic White, 39% non-Hispanic Black, and 28% Hispanic. Fifteen (83%) children were prematurity survivors. Median (range) developmental quotients (DQs): full-scale DQ 59 (11-86), CAT DQ 66.5 (8-96), and CLAMS DQ 49.5 (13-100). Twelve (67%) children were highly suspicious for ASD and/or evolving ID. This cohort of children with at-home IMV demonstrates a higher risk of ASD and ID than prior premature cohorts. Larger investigations with longer follow-up are needed.

Development and Validation of a Vocabulary Measure in the Mobile Toolbox.

We describe the development of a new computer adaptive vocabulary test, Mobile Toolbox (MTB) Word Meaning, and validity evidence from 3 studies. Word Meaning was designed to be a multiple-choice synonym test optimized for self-administration on a personal smartphone. The items were first calibrated online in a sample of 7,525 participants to create the computer-adaptive test algorithm for the Word Meaning measure within the MTB app. In Study 1, 92 participants self-administered Word Meaning on study-provided smartphones in the lab and were administered external measures by trained examiners. In Study 2, 1,021 participants completed the external measures in the lab and Word Meaning was self-administered remotely on their personal smartphones. In Study 3, 141 participants self-administered Word Meaning remotely twice with a 2-week delay on personal iPhones. The final bank included 1363 items. Internal consistency was adequate to good across samples (ρxx = 0.78 to 0.81, p < .001). Test-retest reliability was good (ICC = 0.65, p < .001), and the mean theta score was not significantly different upon the second administration. Correlations were moderate to large with measures of similar constructs (ρ = 0.67-0.75, p < .001) and non-significant with measures of dissimilar constructs. Scores demonstrated small to moderate correlations with age (ρ = 0.35 to 0.45, p < .001) and education (ρ = 0.26, p < .001). The MTB Word Meaning measure demonstrated evidence of reliability and validity in three samples. Further validation studies in clinical samples are necessary.

Establishing language and ethnic equivalence for health-related quality of life item banks and testing their efficiency via computerised adaptive testing simulations.

We aimed to (1) establish linguistic and ethnic equivalence (i.e. lack of bias) for the items in the English and Chinese versions of the Singapore Health and Well Being (SHAWS) Physical Functioning (PF), Positive Mindset (PM) and Social Relationship (SR) item banks (IBs); and (2) evaluate the preliminary efficiency of these IBs using Computer Adaptive Testing (CAT) simulations. In this cross-sectional study, 671, 670, and 672 subjects answered 55, 48 and 30 items of the PF, PM, and SR IBs, respectively. Rasch analysis was conducted to assess each IB's psychometric properties, particularly the presence of differential item functioning (DIF) for language and ethnicity. A set of performance criteria related to removing items that displayed notable DIF were employed. CAT simulations determined the mean number of items for high, moderate, and moderate-low measurement precisions (stopping rule: SEM 0.300, 0.387. 0.521, respectively). Half of subjects were >50 years old (40.9% PF, 42.1% PM, 41.4% SR), Chinese (50.7% PF, 51.0% PM, 50.6% SR) and female (50.0% PF. 49.4% PM, 52.8% SR) respectively. Rasch analysis revealed 4 items with DIF for the PF IB, 9 items with DIF for the PM IB and 2 items with DIF for the SR IB. In CAT simulations, the mean number of items administered was 8.5, 21.6 and 14.5 for the PF, PM and SR IBs, respectively (SEM 0.300), 5.1, 13.0, 8.0 for PF, PM and SR IBs, respectively (SEM 0.387) and 3.1, 5.3 and 4.1 for PF, PM and SR IBs, respectively (SEM 0.521). The PF, PM and SR IBs to measure health-related quality of life revealed minimal DIF for language and ethnicity after remedial efforts. CAT simulations demonstrated that these IBs were efficient, especially when the stopping rule was set at moderate precision, and support the implementation of the SHAWS IBs into routine clinical care.

Impact of psychosocial factors on the success of neuromodulation treatment for patients with persistent pain

IntroductionSignificant interindividual variability in spinal cord stimulation (SCS) outcomes exists. Due to its high cost and risks of complications, criteria to guide patient selection for SCS trials and their outcomes...