Performance-based Measures Research Articles

Social Evaluation in Emerging Adults: Associations with Interpretation Bias and Perceived Social Support.

Social anxiety symptoms are one of the most common mental health concerns across the lifespan (Bandelow and Michaelis in Dialogues Clin Neurosci 17(3):327-335, 2015. https://doi.org/10.31887/DCNS.2015.17.3/bbandelow ) and are especially relevant during emerging adulthood, when social feedback occurs daily (Auxier and Anderson in Social media use in 2021, 2021. https://www.pewresearch.org/internet/2021/04/07/social-media-use-in-2021/ ) as emerging adults navigate new social environments. Two cognitive processes have been identified as relevant to social anxiety: high threat interpretation bias (i.e., the tendency to appraise threat from ambiguity; Rozenman et al. in Behav Ther 45(5):594-605, 2014. https://doi.org/10.1016/j.beth.2014.03.009 ; J Anxiety Disord 45:34-42, 2017. https://doi.org/10.1016/j.janxdis.2016.11.004 ) is associated with high social anxiety, whereas high perceived social support is associated with low social anxiety. In this study, emerging adults (N = 303) completed an online adaptation of the Chatroom task (Guyer et al. in Arch Gener Psychiatry 65(11):1303-1312, 2008. https://doi.org/10.1001/archpsyc.65.11.1303 ), an experimental paradigm designed to simulate social acceptance and rejection, as well as a performance-based measure of interpretation bias (Word Sentence Association Paradigm; Beard and Amir in Behav Res Ther 46(10):1135-1141, 2008. https://doi.org/10.1016/j.brat.2008.05.012 ), and a self-report measure of perceived social support (Multidimensional Scale of Perceived Social Support; Zimet et al. in J Pers Assess 52(1), 30-41, 1988. https://doi.org/10.1207/s15327752jpa5201_2 ). Social anxiety symptoms did not increase as a function of acceptance or rejection during the Chatroom task. However, there were significant interactions between each cognitive predictor and social anxiety change: emerging adults with low interpretation bias towards threat and emerging adults with high perceived social support both experienced decreases in social anxiety from pre- to post-Chatroom task, regardless of whether they were accepted or rejected during the Chatroom task. If replicated, low interpretation bias and high perceived social support may serve as promotive factors in social interactions for emerging adults.

Automating the assessment of multicultural orientation through machine learning and natural language processing.

Recent scholarship has highlighted the value of therapists adopting a multicultural orientation (MCO) within psychotherapy. A newly developed performance-based measure of MCO capacities exists (MCO-performance task [MCO-PT]) in which therapists respond to video-based vignettes of clients sharing culturally relevant information in therapy. The MCO-PT provides scores related to the three aspects of MCO: cultural humility (i.e., adoption of a nonsuperior and other-oriented stance toward clients), cultural opportunities (i.e., seizing or making moments in session to ask about clients' cultural identities), and cultural comfort (i.e., therapists' comfort in cultural conversations). Although a promising measure, the MCO-PT relies on labor-intensive human coding. The present study evaluated the ability to automate the scoring of the MCO-PT transcripts using modern machine learning and natural language processing methods. We included a sample of 100 participants (n = 613 MCO-PT responses). Results indicated that machine learning models were able to achieve near-human reliability on the average across all domains (Spearman's ρ = .75, p < .0001) and opportunity (ρ = .81, p < .0001). Performance was less robust for cultural humility (ρ = .46, p < .001) and was poorest for cultural comfort (ρ = .41, p < .001). This suggests that we may be on the cusp of being able to develop machine learning-based training paradigms that could allow therapists opportunities for feedback and deliberate practice of some key therapist behaviors, including aspects of MCO. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Feasibility of an Application-Based Outpatient Rehabilitation Program for Stroke Survivors: Acceptability and Preliminary Results for Patient-Reported Outcomes.

The majority of stroke survivors experience long-term impairments. Regular physical activity and other lifestyle modifications play an important role in rehabilitation. Outpatient rehabilitation using telemedicine might be suitable to improve functional ability and long-term secondary prevention. The Strokecoach Intervention Program (SIP, Strokecoach GmbH, Cologne, Germany) comprises training, coaching and monitoring with the aim of improving or at least maintaining functional independence and preventing further stroke through more targeted physical activity. The SIP is provided as blended care, which refers to the integrated and coordinated delivery of healthcare services that combines traditional in-person interactions with technology-mediated interventions, optimizing the use of both face-to-face and virtual modalities to enhance patient outcomes. The aim of this study was to evaluate the acceptance of the SIP by the participants and its practical application, as well as to obtain initial indications of effects of the SIP on the basis of patient-related outcome measures, blood pressure measurements and recording of physical activity in parallel with the intervention. Data from individuals with stroke participating in the SIP were analyzed retrospectively. Within the SIP, participants received an application-based training program, were instructed to measure their blood pressure daily and to wear an activity tracker (pedometer). During the intervention period of either 6 or 12 weeks, the participants were supported and motivated by a personal coach via a messenger application. The primary outcomes of the analysis were recruitment, acceptance of and satisfaction with the SIP. Secondary outcomes included functional measures, mobility and health-related quality of life. A total of 122 individuals with stroke could be recruited for the SIP. A total of 96 out of 122 were able to start the program (54% female, mean age 54.8 (SD = 13.1), 6.1 (SD = 6.6) years after stroke onset) and 88 completed the SIP. Participants wore the activity tracker on 66% and tracked their blood pressure on 72% of their intervention days. A further analyzed subgroup of 38 participants showed small improvements in patient-reported outcomes such as health-related quality of life (SF-36) with an increase of 12 points in the subdomain mental health, vitality (12.6) and physical functioning (9.1). However, no statistically significant improvements were found in other performance-based measures (Timed Up and Go test, gait speed). This study showed that a blended therapy approach for stroke survivors with mild to moderate impairments in the chronic phase is feasible and was highly accepted by participants, who benefitted from the additional coaching.

Responsiveness of Isokinetic Dynamometry in Patients with Osteoarthritis after Knee and Hip Arthroplasty: A Prospective Repeated-Measures Cohort Study

Functional assessments are crucial for the evaluation of rehabilitation after total knee (TKA) and hip (THA) arthroplasty. Muscle strength, a key determinant of physical function (PF), is often measured with isokinetic dynamometry (ID), which is considered the gold standard. However, studies lack evaluations of responsiveness—the ability to detect changes over time. This study aims to determine the responsiveness of ID in measuring PF in TKA and THA rehabilitation—is muscle strength a valid indicator for assessing improvement in rehabilitation processes? The pre- and post-surgery PF of 20 osteoarthritis patients (age 55–82) was assessed, using ID, performance-based and self-reported measures. Responsiveness was evaluated by comparing the observed relationship of changes in ID and PF scores with the a priori defined expected relationship of change scores. While the performance-based and self-reported measures showed significant improvements post-surgery (Cohen’s d [0.42, 1.05] p &lt; 0.05), ID showed no significant differences. Moderate correlations were found between changes in some ID parameters and selected functional tests (r ≈|0.5|, p &lt; 0.05). Responsiveness was solely found for the peak torque of knee extension at 180°/s on the operated side. Responsiveness is an often-overlooked psychometric property of outcome measurements. The findings suggest that ID may not be fully responsive to the construct of PF after TKA and THA, raising questions about its role and usefulness in this context and the need for more appropriate assessment methods.

Early life parechovirus infection neuropsychological outcomes at 8 years: a cohort study

ABSTRACT Human parechovirus (HPeV) is a leading cause of Central Nervous System (CNS) infection in infancy. Despite this, little is known regarding the long-term neuropsychological impacts from HPeV infection. The aim of the present study was to explore the long-term neuropsychological impacts eight-year post-HPeV infection contracted during infancy. This study also aimed to investigate the differential impacts of HPeV itself compared to the effects of secondary meningitis (n = 23) or encephalitis (n = 3) associated with HPeV infection. Thirty-nine HPeV children participated in the study. Children completed performance-based measures of neuropsychological and language functioning (the Wechsler Abbreviated Scale of Intelligence, the Clinical Evaluation of Language Fundamentals – Fourth Edition, and the Test of Everyday Attention for Children). Parents completed questionnaire-based measures of emotional, behavioral, and pragmatic language functioning (the Behaviour Rating Inventory of Executive Functioning, the Child Behavior Checklist, and the Social Communication Questionnaire). Results revealed that, overall, children with HPeV were significantly more impaired on measures of selective, sustained, and divided attention compared to normative test populations. The current study incidentally found at least double the prevalence of Attention-Deficit/Hyperactivity Disorder (ADHD) in the HPeV sample than what is typical in the normal population, suggesting that HPeV infection during infancy may be a risk factor for the later development of ADHD. Additionally, the presence of secondary meningitis or encephalitis did not relate to poorer neuropsychological outcomes in the current sample. The findings of this study have important implications regarding clinical management for children following HPeV infection in infancy.

Examination of Construct Validity of ANX and DEP Scales of the PAI-A

Anxiety and depression are the two most common psychiatric problems of adolescence. The Personality Assessment Inventory, Adolescent Version (PAI-A) is a broadband instrument designed to assist in the detection and differential diagnosis of common psychiatric disorders in adolescents, and it includes a Depression scale (DEP) to detect the presence of major depressive episodes and an Anxiety scale (ANX) designed to detect clinically significant anxiety. However, there is limited research on this measure. The current study examined both the convergent and discriminant validities of the PAI-A Anxiety and Depression scales by observing their relationships to other self-report measures (e.g., PAI-A scales, MMPI-A), observer ratings (e.g., HPRS), and performance-based measures (e.g., Rorschach CS). The sample consisted of 352 records of the psychological assessments of adolescent inpatients between the ages of 13 to 17; the sample was about equally male (51.6%) and female with a mean age of 15.5 years. The sample was ethnically diverse with 48.7% of individuals identifying as Caucasian, 12.9% Black, 16% Hispanic, 2.6% Asian, 3.2% Other, and 16.6% unknown. There is strong evidence for convergent validity for the PAI–A ANX and DEP scales with r’s ranging from .11 to .78. There is moderate evidence for discriminant validity for these scales. Results demonstrated that PAI–A scales correlated strongest with self-report, followed by therapist rating scale, and then performance-based measures. Various strengths of the PAI-A for the assessment of anxiety and depression are discussed.

Impaired emotional awareness is associated with childhood maltreatment exposure and positive symptoms in schizophrenia.

Evidence suggests that emotional awareness-the ability to identify and label emotions-may be impaired in schizophrenia and related to positive symptom severity. Exposure to childhood maltreatment is a risk factor for both low emotional awareness and positive symptoms. The current investigation examines associations between a performance-based measure of emotional awareness, positive symptom severity, and childhood maltreatment exposure in 44 individuals with a schizophrenia-spectrum disorder and 48 healthy comparison participants using the electronic Levels of Emotional Awareness Scale (eLEAS), Positive and Negative Syndrome Scale (PANSS) and Childhood Trauma Questionnaire (CTQ). Patients demonstrated significant deficits in emotional awareness overall, which was true for both self and others. In patients, lower emotional awareness was significantly associated with more severe positive symptoms. Emotional awareness was significantly impaired in patients with schizophrenia with self-reported maltreatment exposure, relative to other groups. Severity of maltreatment was not significantly associated with emotional awareness or positive symptoms when looking continuously, and there was no significant indirect effect. These data suggest that emotional awareness impairments observed in schizophrenia may be exacerbated by exposure to childhood maltreatment, possibly putting individuals at greater risk for experiencing positive symptoms of psychosis.

Performance-based attentional control, but not self-reported attentional control, predicts changes in depressive symptoms in short-term psychotherapy

ObjectiveAlthough impairments in attentional control are pervasive across psychopathology, there is substantial individual differences. In the current study, we examined whether individual differences in self-reported and performance-based measures of attentional control predict changes in depressive symptoms and well-being in a diagnostically diverse sample of patients attending a CBT-based partial hospital program. MethodParticipants were 89 patients (56.2% men, 75.3% non-Hispanic White). At baseline, patients completed the self-reported Attentional Control Scale and the Rapid Serial Visual Presentation task (RSVP), a behavioral measure of attentional control. Depressive symptoms were assessed daily using the Patient Health Questionnaire and well-being was assessed using the Mental Health Continuum Short Form. ResultsOn average, greater self-reported attentional control was significantly associated with lower depressive symptoms, β = −0.49, t(52) = 4.84, p < .001, 95% CIs [−0.69, −0.29], and greater well-being, β = 0.45, t(53) = 3.90, p < .001, 95% CIs [0.22, 0.67]. More accurate task-based performance was associated with a decline in depressive symptoms over time, β = −0.02, t(32) = 2.50, p = .02, 95% CIs [−0.04, −0.01]. Neither self-reported nor performance-based measures of attentional control predicted changes in well-being. Finally, exploratory analyses suggest that depressive symptoms also improved over time for individuals who underestimated self-reported attentional control abilities relative to task-based performance, β = −0.19, t(32) = 2.23, p = .03, 95% CIs [−0.36, −0.02]. ConclusionsResults suggest that performance-based attentional control may be an important target for assessment and intervention, as well as a potential mechanism underlying risk and recovery.

Novel computerized measure of apathy associates with care partner burden and instrumental activities of daily living in Parkinson's disease

BackgroundImpairment in goal-directed behavior (GDB) contributes to apathy, a prevalent syndrome in Parkinson's disease (PD). The Philadelphia Apathy Computerized Task (PACT) is a performance-based measure of GDB that may be less confounded by reduced patient insight, cognitive impairment, and care partner burnout. ObjectiveTo examine how the PACT is related to patient function and care partner burden. MethodsPD patients with normal cognition (n = 19) or mild cognitive impairment (n = 14) and their care partners were recruited. Participants completed the PACT, a computerized paradigm consisting of subtasks specific to each component of GDB: initiation, motivation, and planning. Care partners completed the Zarit Burden Interview (ZBI) and the Penn Parkinson's Daily Activities Questionnaire (PDAQ-15). The associations between mean latency on each PACT subtask and ZBI and PDAQ-15 scores, respectively, were tested using Spearman's rank correlation coefficients. Significant associations were further delineated using multivariate regression with the following covariates: age, years of education, MoCA score, daily levodopa equivalency dose, UPDRS Part III score, and GDS-15 score. ResultsWorse performance on the planning subtask of the PACT related to higher ZBI scores and lower PDAQ-15 scores when adjusting for covariates. Decreased initiation was associated with higher ZBI and decreased motivation with lower PDAQ-15. ConclusionsSpecific components of the PACT are related to patient and care partner outcomes in PD. The main advantage of this measure is to minimize the confounds of poor insight and care partner distress. We propose future research directions to refine the PACT for potential use in research and clinical practice.

Multisensory processing and proprioceptive plasticity during resizing illusions.

Bodily resizing illusions typically use visual and/or tactile inputs to produce a vivid experience of one's body changing size. Naturalistic auditory input (an input that reflects the natural sounds of a stimulus) has been used to increase illusory experience during the rubber hand illusion, whilst non-naturalistic auditory input can influence estimations of finger length. We aimed to use a non-naturalistic auditory input during a hand-based resizing illusion using augmented reality, to assess whether the addition of an auditory input would increase both subjective illusion strength and measures of performance-based tasks. Forty-four participants completed the following three conditions: no finger stretching, finger stretching without tactile feedback and finger stretching with tactile feedback. Half of the participants had an auditory input throughout all the conditions, whilst the other half did not. After each condition, the participants were given one of the following three performance tasks: stimulated (right) hand dot touch task, non-stimulated (left) hand dot touch task, and a ruler judgement task. Dot tasks involved participants reaching for the location of a virtual dot, whereas the ruler task concerned estimates of the participant's own finger on a ruler whilst the hand was hidden from view. After all trials, the participants completed a questionnaire capturing subjective illusion strength. The addition of auditory input increased subjective illusion strength for manipulations without tactile feedback but not those with tactile feedback. No facilitatory effects of audio were found for any performance task. We conclude that adding auditory input to illusory finger stretching increased subjective illusory experience in the absence of tactile feedback but did not affect performance-based measures.

בדיקת תוקף של מטלה ביצועית בלתי מובנית (UPT), למדידת תפקודים ניהוליים בקרב ילדים

Background: Executive Functions (EFs) are assessed by performance-based measures in clinical settings and rating scales in ecological settings. Research has shown a lack of a correlation between both methods. In order to bridge the gap, the Unstructured Performance-Based Task (UPT) was developed. This assessment includes 42 questions randomly presented on a large piece of paper and is accompanied by a behavioral checklist. Aim: To examine the construct validity of the UPT and the behavioral checklist by examining group differences in UPT scores between children with and without Attention Deficit Hyper Disorder (ADHD) and EF deficits A further aim is to examine associations between the UPT and performance-based measures and rating scales. Method: The UPT was translated and culturally adapted for Hebrew speaking children in Israel. Participants were 42 children (aged 8-11 years), 21 with ADHD and EF deficits and 21 without a diagnosis or EF deficit. Parents completed a sociodemographic questionnaire, the Performance Skills Questionnaire, and the Behavior Rating Inventory of Executive Function (BRIEF) to assess EF deficits in ecological settings. Children completed the UPT and other widely used assessments: Digit Span Forward and Backward, Verbal Working Memory, Trail Making Test, and Tower of Hanoi. Results: Significant differences were found between groups in some of the UPT measures and the behavioral checklist. Associations were found between some UPT measures and the behavioral checklist and performance-based EF measures, as well as the BRIEF rating scale. Conclusions: The measures of Total Correct Items, Total Blank Items, and completion time in UPT may be valid for EFs assessment. The behavioral checklist may be a valid assessment for behavior in ecological settings. The UPT may assist in identifying EF deficits in children and setting goals in Occupational Therapy interventions.

The Economic Value of Cross-predictability: A Performance-based Measure

The Economic Value of Cross-predictability: A Performance-based Measure

Clinically relevant differences in spinal mobility related to daytime performance in patients with axial spondyloarthritis

ObjectivePatients with axial spondyloarthritis (axSpA) suffer from clinical symptoms like morning stiffness and back pain. Mobility of patients with axSpA is often impaired. The aim of this study is to...

Motor Skills, Social Skills, and Participation of Autistic Children

Generally, participation levels of autistic children are lower than neurotypical children in social and physical activities. The range of activities that autistic children participate in is also less diverse. Building on previous qualitative work, the current research provides a quantitative perspective to explore the relationship between social skills and motor skills in autistic children, and the association with participation at home, school, and in the community. Caregivers and their 5-to-11-year-old autistic children participated in this research. Motor skills were assessed with performance-based (BOT-2-SF) and caregiver-report measures (MABC-2 checklist). Caregivers also completed questionnaires to quantify social skills (SRS-2) and participation (PEM-CY) patterns. Motor assessments were not correlated, suggesting use of the MABC-2 checklist in conjunction with the BOT-2-SF may not be well-suited for younger participants. Discordant results of proxy (i.e., social/motor skills predicted participation frequency at school, with social skills contributing to the model) and performance-based (i.e., social/motor skills predicted participation frequency at home, and average involvement in the community) reports were attributed to caregiver's focus on fine motor performance in school-based settings, considering the established link between social and fine motor skills in autism. Non-significant findings were explained by heterogeneity in social/motor skills among autistic children. Overall, while continued research is warranted, findings support a person-centered (i.e., individualized) approach to address participation of autistic children.

Rule by Metrics

Abstract We live in societies in which an ever-growing array of activities in a range of fields are assessed, controlled and governed according to quantitative techniques. This paper focuses on processes grounded on quantitative tools (e.g. scores, indicators, rankings, algorithms) that are used in order to measure the performance of processes, people or organizations. Such processes are referred to in this paper as ‘legal metrics’. We explore how different legal systems and sectors rely on legal metrics, and develop a twofold argument. On the one hand, we argue that performance-based quantification often qualifies as a form of regulatory intervention. On the other hand, we contend that performance-based measures are always adopted and applied in legal contexts that react differently to the quantification turn. Both sides of this picture have largely been overlooked by comparative lawyers, even though they imply looking for law in extraordinary places and appraising a variety of legal manifestations in different settings. Understanding which forms of quantitative measures are widespread, in which sectors and regions, made by whom and producing what regulatory effects, is a research task that could (and in our opinion should) be of interest for all comparative law scholars.

Using Knowledge Construction Theory to Evaluate Learning Processes: A Randomized Controlled Trial on Showing Gradually Built-up Concept Maps Alongside a Scientific Text

Scientific texts convey new and complex information relevant not only to researchers but also to lay audiences. We present a randomized controlled trial that investigated whether showing a concept map, gradually building up as a user reads a scientific text, supports the cognitive processes of knowledge construction. The intervention group (n = 44) exhibited significantly more knowledge construction [t(89) = 1.94, p = .029, d = 0.41] than the control group (n = 47). The intervention supported basic knowledge construction, i.e., simple processing of information, but not medium and complex levels. This study makes two contributions: (1) showing interactive concept maps and building them up gradually alongside reading helps make scientific texts cognitively more accessible to a lay audience, e.g., to inform public debate, and (2) knowledge construction theory can be used as a theoretical foundation for measuring specific aspects of learning processes—complementing other metrics for comparative design examinations, e.g., usability, user experience, or performance-based measures.

EXPANDING INSIGHTS INTO LATE-LIFE DISABILITY USING OBJECTIVE ASSESSMENTS IN NHATS

Abstract The National Health and Aging Trends Study (NHATS) is a NIA-funded national panel study that conducts annual in-home interviews with a representative sample of US Medicare beneficiaries ages 65 years and older. Designed as a platform for the scientific study of late life disability trends and trajectories, NHATS fosters research to guide efforts to maximize health, promote independent functioning, and enhance quality of life at older ages. NHATS has collected performance-based measures of physical function since its inception (2011). In 2021 NHATS responded to expanded interest in objective measures of sensory loss and physical activity, by adding measures of vision (visual acuity, contrast sensitivity), hearing (pure tone audiometry), and physical activity (accelerometry). This symposium will introduce these measures and demonstrate their scientific application to answer key research questions related to physical and cognitive health. Dr. Schrack will present an overview of the accelerometry data collection procedures, as well as results by key demographic and health-related features. Dr. Twardzik will examine the association between features of participants’ social and physical environments and patterns of accelerometry-based physical activity. Dr. Martinez-Amezcua will examine the association between hearing and phenotypic frailty. Dr. Davoudi will present evidence on the links among sensory and motor function and risk of dementia. Finally, Dr. Wanigatunga will describe the association between measures of hand and leg strength and dementia incidence. Collectively, these presentations will highlight population-level associations of objective measures of health and function with physical and cognitive outcomes to advance the science of disability in older adults.

Smartphone-based gait assessment for multiple sclerosis

IntroductionMultiple Sclerosis causes gait alteration, even in the early stages of the disease. Traditional methods to quantify gait impairment, such as performance-based measures, lab-based motion analyses, and self-report, have limited ecological relevance. The Mon4t® app is a digital tool that uses sensors embedded in standard smartphones to measure various gait parameters. ObjectivesTo evaluate the use of Mon4t® technology in monitoring MS patients. Methods100 MS patients and age-matched healthy controls were evaluated using both a human rater and the Mon4t Clinic™ app. Three motor tasks were performed: 3m Timed up and go test (TUG), 10m TUG, and tandem walk. The digital markers were used to compare MS vs. HC, MS with EDSS=0 vs. HC, and MS with EDSS=0 vs. MS with EDSS>0. Within the MS EDSS>0 group, correlations between digital gait markers and the EDSS score were calculated. ResultsSignificant differences were found between MS patients and HC in multiple gait parameters. When comparing MS patients with minimal disability (EDSS=0) and HC: On the 3m TUG task, MS patients took longer to complete the task (mean difference 0.167seconds, p =0.034), took more steps (mean difference 1.32 steps, p =0.003), and had a weaker ML step-to-step correlation (mean difference 0.1, p = 0.001). The combination of features from the three motor tasks allowed distinguishing a nondisabled MS patient from a HC with high confidence (AUC of 85.65 on the ROC). When comparing MS patients with minimal disability (EDSS=0) to those with higher disability (EDSS>0): On the tandem walk task, patients with EDSS>0 took significantly longer to complete 10 steps than those with EDSS=0 (mean difference 4.63 seconds, p < 0.001), showed greater ML sway (mean difference 0.2, p < 0.001), and had larger angular velocity in the SI axis on average (mean difference 2.31 degrees/sec, p = 0.01). A classification model achieved 81.79 ROC AUC. In the subgroup of patients with EDSS>0, gait features significantly correlated with EDSS score in all three tasks. ConclusionThe findings demonstrate the potential of digital gait assessment to augment traditional disease monitoring and support clinical decision making. The Mon4t® app provides a convenient and ecologically relevant tool for monitoring MS patients and detecting early changes in gait impairment.

Exploring the Utility of the Rorschach Test in Predicting Weight Loss After Bariatric Surgery

Abstract: Bariatric surgery (BS) is an effective approach to treat severe obesity, which should include multidisciplinary care. Prior to surgery, candidates for BS usually undergo a psychological assessment based mostly on self-report of clinical symptoms. However, the results of this assessment are not always sufficient to predict outcomes. Therefore, this study examined the potential of a multimethod approach to assessing patients seeking BS using both self-report and performance-based measures of cognitive and affective functioning. A sample of 50 women who had applied for surgery at a public facility in Brazil were assessed with the Difficulties in Emotion Regulation Scale (DERS), the Rorschach Performance Assessment System (R-PAS), and the Trail Making Test (TMT). Patients who dropped out before treatment ( n = 27) had higher initial body mass index and poorer performance on cognitive flexibility at baseline. In the remaining 23 patients who underwent surgery, indicators of emotional and cognitive functioning from all measures were associated with weight loss (WL) at 6 and 12 months after surgery. However, only R-PAS variables regarding psychological resources were associated with WL 18 months after surgery. We discuss the usefulness of the Rorschach as a source of information for patients seeking BS and the implications for current assessment practices in the field.

Link criticality index: Refinement, framework extension, and a case study

The link criticality index (LCI) is a network performance-based measure that assesses criticality of network links based on flow fluctuations during traffic assignment. Unlike other network performance-based methods, LCI does not require link removal or multiple traffic assignments, and can account for topology, redundancy, congestion, and traveler behavior. However, the original LCI is based on a deterministic user equilibrium (UE) framework, which may lead to two issues: (i) a link's criticality index can be affected by origin-destination (O-D) pairs even if their demand is routed away from the link and (ii) identical links can be ranked unequally. In this paper, we suggest a refinement to the functional form of LCI to cater to analysts who prefer to work within the UE framework; and we extend the LCI measure to stochastic user equilibrium (SUE) and SUE with elastic demand (ED). These extensions resolve the issues related to UE-based LCI and add to the behavioral realism of the network model. To demonstrate validity of concept, the resulting LCI measure is applied to assess the criticality of bridges in Winnipeg, Canada. The obtained results are reasonable and consistent with the previous methods based on the full-network scan approach.